Provider Demographics
NPI:1063108363
Name:PAK, GRAZYNA ANNA
Entity type:Individual
Prefix:
First Name:GRAZYNA
Middle Name:ANNA
Last Name:PAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N HOWARD ST STE 5256
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0508
Mailing Address - Country:US
Mailing Address - Phone:602-386-0560
Mailing Address - Fax:
Practice Address - Street 1:14535 NE BEL RED RD STE 200
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3907
Practice Address - Country:US
Practice Address - Phone:425-955-1891
Practice Address - Fax:425-955-1891
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP614188806363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty