Provider Demographics
NPI:1689342537
Name:GRADY, MARTHA SMITH (RN)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:SMITH
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 1:160 N PHARMA DR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-9570
Mailing Address - Country:US
Mailing Address - Phone:919-215-3121
Mailing Address - Fax:
Practice Address - Street 1:160 N PHARMA DR
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-9570
Practice Address - Country:US
Practice Address - Phone:919-215-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC80074163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty