Individual
BLISS GRADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2817 NEW PINERY RD, PORTAGE, WI 53901-9240
(608) 742-4131
Mailing address
2817 NEW PINERY RD, PORTAGE, WI 53901-9240
(952) 843-8443
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1220986
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/26/2023
Last updated
02/13/2025
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