Individual
GRACE MIRAN PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
33507 9TH AVE S STE A, FEDERAL WAY, WA 98003-6397
(253) 874-5404
(253) 874-8964
Mailing address
33507 9TH AVE S STE A, FEDERAL WAY, WA 98003-6397
(253) 874-5404
(253) 874-8964
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP60616120
WA
363LF0000X
Family Nurse Practitioner
NP95002165
CA
363LP2300X
Primary Care Nurse Practitioner
AP60616120
WA
Other
Enumeration date
08/20/2015
Last updated
04/17/2018
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