Provider Demographics
NPI:1548484165
Name:GRADY, CARRIE LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:LYNN
Last Name:GRADY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 642117
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-8117
Mailing Address - Country:US
Mailing Address - Phone:402-717-4377
Mailing Address - Fax:402-717-4317
Practice Address - Street 1:122 W 8TH ST
Practice Address - Street 2:ALEGENT HEALTH
Practice Address - City:LOGAN
Practice Address - State:IA
Practice Address - Zip Code:51546-1416
Practice Address - Country:US
Practice Address - Phone:712-644-3288
Practice Address - Fax:712-644-2549
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA37515207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine