Provider Demographics
NPI:1386173524
Name:GRACE, ANNA (PA)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:GRACE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:GRACE
Other - Last Name:ADAMCZYK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11603 STATE AVE STE G
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-8465
Mailing Address - Country:US
Mailing Address - Phone:360-658-6800
Mailing Address - Fax:
Practice Address - Street 1:11603 STATE AVE STE G
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-8465
Practice Address - Country:US
Practice Address - Phone:360-658-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-10
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
WAPA61252446363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant