Individual
MR. BRUCE ALAN GRADOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.N.
Contact information
Practice address
2215 FULLER RD, ANN ARBOR, MI 48105-2303
(734) 769-7100
(734) 845-3296
Mailing address
2215 FULLER RD, ANN ARBOR, MI 48105-2303
(734) 769-7100
(734) 845-3296
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704193798
MI
163WE0003X
Emergency Registered Nurse
4704193798
MI
163WH0200X
Home Health Registered Nurse
4704193798
MI
Other
Enumeration date
03/14/2012
Last updated
03/14/2012
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