Individual
MS. STEPHANIE GRADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA & NP
Contact information
Practice address
410 CHURCH ST SE, MINNEAPOLIS, MN 55455-0222
(612) 625-2612
Mailing address
PO BOX 43, MR 10809, MINNEAPOLIS, MN 55440-0043
(612) 262-4813
(612) 262-4194
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
9028
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
326725300
—
MN
Enumeration date
03/24/2006
Last updated
07/21/2022
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