Provider Demographics
NPI:1619753753
Name:GRIZZLE, LASCELLE CLARENCE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:LASCELLE
Middle Name:CLARENCE
Last Name:GRIZZLE
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 NE PACIFIC STREET
Mailing Address - Street 2:T-301
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-7263
Mailing Address - Country:US
Mailing Address - Phone:253-287-0670
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC STREET
Practice Address - Street 2:T-301
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-7263
Practice Address - Country:US
Practice Address - Phone:253-287-0670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2025-11-05
Deactivation Date:2024-04-10
Deactivation Code:
Reactivation Date:2025-11-05
Provider Licenses
StateLicense IDTaxonomies
WARN61057523390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program