Individual
VERA GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
1818 COLE ST FL 1, ENUMCLAW, WA 98022-3504
(360) 802-5032
(360) 802-5039
Mailing address
1818 COLE ST FL 1, ENUMCLAW, WA 98022-3504
(360) 802-5032
(360) 802-5039
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA61114885
WA
363AM0700X
Medical Physician Assistant
Primary
PA61114885
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2173403
—
WA
Enumeration date
08/19/2019
Last updated
08/15/2024
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