Provider Demographics
NPI:1114343951
Name:GRADY, GEMMA (RN)
Entity Type:Individual
Prefix:
First Name:GEMMA
Middle Name:
Last Name:GRADY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 BRIDGE VIEW DR STE 600
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-8415
Mailing Address - Country:US
Mailing Address - Phone:843-953-0857
Mailing Address - Fax:
Practice Address - Street 1:4050 BRIDGE VIEW DR STE 600
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-8415
Practice Address - Country:US
Practice Address - Phone:843-953-0857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37549163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator