Provider Demographics
NPI:1174589337
Name:BRADY, ROSEMARY J (ARNP)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:J
Last Name:BRADY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 S SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428-2552
Mailing Address - Country:US
Mailing Address - Phone:641-357-3709
Mailing Address - Fax:
Practice Address - Street 1:300 15TH ST NE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-1222
Practice Address - Country:US
Practice Address - Phone:641-423-5044
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF-061336363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0057026Medicaid
IA0057026Medicaid