Provider Demographics
NPI:1568994440
Name:GRADY, TRACI (RN)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:
Last Name:GRADY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:
Other - Last Name:LAYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:100 CHICKASAW ST
Mailing Address - Street 2:
Mailing Address - City:RUDD
Mailing Address - State:IA
Mailing Address - Zip Code:50471-5018
Mailing Address - Country:US
Mailing Address - Phone:641-220-0303
Mailing Address - Fax:
Practice Address - Street 1:408 1ST ST NW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401
Practice Address - Country:US
Practice Address - Phone:641-424-8708
Practice Address - Fax:641-421-7809
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA089503163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult