Provider Demographics
NPI:1407396617
Name:GRADY, JANEL (STNA)
Entity type:Individual
Prefix:
First Name:JANEL
Middle Name:
Last Name:GRADY
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23755 BANBURY CIR
Mailing Address - Street 2:16D
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5308
Mailing Address - Country:US
Mailing Address - Phone:216-544-1473
Mailing Address - Fax:
Practice Address - Street 1:23755 BANBURY CIR
Practice Address - Street 2:16D
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5308
Practice Address - Country:US
Practice Address - Phone:216-544-1473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400587400207376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide