Provider Demographics
NPI:1316964158
Name:WARD, ANN GRUMMEL (ANP, PMHNP)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:GRUMMEL
Last Name:WARD
Suffix:
Gender:F
Credentials:ANP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4049
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4049
Mailing Address - Country:US
Mailing Address - Phone:503-706-9791
Mailing Address - Fax:503-536-6719
Practice Address - Street 1:758 NW POWHATAN TER
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2731
Practice Address - Country:US
Practice Address - Phone:503-894-9810
Practice Address - Fax:503-536-6719
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR90007316N3363LA2200X
OR200450068NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
054123026OtherBLUE CROSS
R130646Medicare ID - Type Unspecified