Individual
KATHLEEN GRADOVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1212 PLEASANT ST, SUITE 204, DES MOINES, IA 50309-1453
(515) 241-6548
(515) 241-8789
Mailing address
1212 PLEASANT ST, SUITE 204, DES MOINES, IA 50309-1453
(515) 241-6548
(515) 241-8789
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
C81143
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285626390
—
IA
05
—
1285626390
—
MO
01
—
17515013
MEDICARE
IA
Enumeration date
08/16/2005
Last updated
11/18/2011
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