Individual
LAURA S. GRANTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
2320 FREEWAY DR, MOUNT VERNON, WA 98273-5445
(360) 428-2550
(360) 428-6402
Mailing address
1400 E. KINCAID STREET, ATTN: CREDENTIALING, MOUNT VERNON, WA 98274-4127
(360) 428-2500
(360) 428-6485
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
AL2999
FL
363A00000X
Physician Assistant
PA60617391
WA
363AM0700X
Medical Physician Assistant
Primary
PA60617391
WA
Other
Enumeration date
01/11/2011
Last updated
09/22/2021
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