Provider Demographics
NPI:1942639588
Name:GRODE, MARY (NSCA-CPT, NAR)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:GRODE
Suffix:
Gender:F
Credentials:NSCA-CPT, NAR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MALFAIT TRACTS RD
Mailing Address - Street 2:
Mailing Address - City:WASHOUGAL
Mailing Address - State:WA
Mailing Address - Zip Code:98671-7820
Mailing Address - Country:US
Mailing Address - Phone:360-837-3663
Mailing Address - Fax:
Practice Address - Street 1:21 MALFAIT TRACTS RD
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-7820
Practice Address - Country:US
Practice Address - Phone:360-837-3663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANA 00149225374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide