Provider Demographics
NPI:1962077339
Name:GRADISEK, ALAYNA MARIE
Entity type:Individual
Prefix:
First Name:ALAYNA
Middle Name:MARIE
Last Name:GRADISEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 PATTON DR
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-9169
Mailing Address - Country:US
Mailing Address - Phone:724-777-3167
Mailing Address - Fax:
Practice Address - Street 1:237 PATTON DR
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-9169
Practice Address - Country:US
Practice Address - Phone:724-777-3167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP023618363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health