Organization
APACHE JUNCTION PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANET GRADLE CPNP (CERTIFIED PEDIATRIC NURSE PRACTIONE)
(480) 889-1234
Entity
Organization
Contact information
Practice address
1075 S IDAHO RD, SUITE 206, APACHE JUNCTION, AZ 85219-6496
(480) 889-1234
Mailing address
1075 S IDAHO RD, SUITE 206, APACHE JUNCTION, AZ 85219-6496
(480) 889-1234
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
27900
AZ
208000000X
Pediatrics Physician
34587
AZ
208000000X
Pediatrics Physician
34596
AZ
208000000X
Pediatrics Physician
Primary
AP0241
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
088674
—
AZ
05
—
524729
—
AZ
05
—
907397
—
AZ
05
—
971409
—
AZ
01
—
AZ0427690
RL BC ID
AZ
01
—
AZ0763370
JB BC ID
AZ
05
—
F14456
—
AZ
Enumeration date
06/04/2007
Last updated
08/22/2020
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