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Individual

NICHOLAS JOSEPH GRINNELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
808 N 5TH AVE, SEQUIM, WA 98382-3045
(360) 683-5900
Mailing address
81 STREIT RD, SEQUIM, WA 98382-7553
(360) 461-1133

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA61309930
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PA61309930
PROVIDER CREDENTIAL NUMBER
WA
Enumeration date
07/26/2022
Last updated
07/26/2022
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