Provider Demographics
NPI:1508291238
Name:O'GRADY, THERESE MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:THERESE
Middle Name:MARIE
Last Name:O'GRADY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:THERESE
Other - Middle Name:MARIE
Other - Last Name:ZEI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 939
Mailing Address - Street 2:
Mailing Address - City:PELL LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:53157-0939
Mailing Address - Country:US
Mailing Address - Phone:262-215-8747
Mailing Address - Fax:262-295-8338
Practice Address - Street 1:W1007 VIOLET RD
Practice Address - Street 2:
Practice Address - City:GENOA CITY
Practice Address - State:WI
Practice Address - Zip Code:53128-1666
Practice Address - Country:US
Practice Address - Phone:262-215-8747
Practice Address - Fax:262-295-8338
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI86757-030163W00000X
IL041.190108163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse