Provider Demographics
NPI:1336600618
Name:GRADY, DENISE MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:GRADY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:DENISE
Other - Middle Name:M
Other - Last Name:GRANDSTAFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:3850 WHITE PETALS CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-6052
Mailing Address - Country:US
Mailing Address - Phone:336-529-4120
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-3520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011629207UN0902X, 363LG0600X, 363L00000X
NY5011629363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology