Provider Demographics
NPI:1972081164
Name:GREBECK, ANASTASIA ELIZABETH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ANASTASIA
Middle Name:ELIZABETH
Last Name:GREBECK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANASTASIA
Other - Middle Name:ELIZABETH
Other - Last Name:KIRSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3028 JAVIER RD STE 300
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4622
Mailing Address - Country:US
Mailing Address - Phone:703-698-8960
Mailing Address - Fax:
Practice Address - Street 1:3028 JAVIER RD STE 300
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4622
Practice Address - Country:US
Practice Address - Phone:703-698-8960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110006276363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant