Individual
MICHAEL J. GRODESKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
1959 NE PACIFIC ST, SEATTLE, WA 98195-0001
(206) 598-8750
Mailing address
PO BOX 24366, SEATTLE, WA 98124-0366
(206) 598-0502
(206) 598-0516
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN00154484
WA
363LA2200X
Adult Health Nurse Practitioner
Primary
AP30006742
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0193918
LABOR & INDUSTRIES
WA
05
—
9644238
—
WA
01
—
U56897
REGENCE BLUESHIELD
WA
Enumeration date
07/17/2006
Last updated
10/11/2007
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