Provider Demographics
NPI:1962851337
Name:GRADUS, BARBRA LONG (FNP-BC)
Entity Type:Individual
Prefix:
First Name:BARBRA
Middle Name:LONG
Last Name:GRADUS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 MADRONE ST
Mailing Address - Street 2:
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-4249
Mailing Address - Country:US
Mailing Address - Phone:707-456-3062
Mailing Address - Fax:707-456-3063
Practice Address - Street 1:84 MADRONE ST
Practice Address - Street 2:
Practice Address - City:WILLITS
Practice Address - State:CA
Practice Address - Zip Code:95490-4249
Practice Address - Country:US
Practice Address - Phone:707-456-3062
Practice Address - Fax:707-456-3063
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016871363LF0000X
NYF340298-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily