Provider Demographics
NPI:1427706217
Name:GRAYFER, NADIA ELAINE
Entity type:Individual
Prefix:
First Name:NADIA
Middle Name:ELAINE
Last Name:GRAYFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NADEZHDA
Other - Middle Name:PETROVNA
Other - Last Name:VILLALONGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:321 125TH PL SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-6417
Mailing Address - Country:US
Mailing Address - Phone:206-302-8514
Mailing Address - Fax:
Practice Address - Street 1:321 125TH PL SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-6417
Practice Address - Country:US
Practice Address - Phone:206-302-8514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-11
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61398453363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily