Provider Demographics
NPI:1073056644
Name:GREWAL, JASVIR (OWNER)
Entity Type:Individual
Prefix:
First Name:JASVIR
Middle Name:
Last Name:GREWAL
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 GINKGO ST SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-6420
Mailing Address - Country:US
Mailing Address - Phone:253-929-8263
Mailing Address - Fax:253-929-6244
Practice Address - Street 1:1403 GINKGO ST SE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-6420
Practice Address - Country:US
Practice Address - Phone:253-929-8263
Practice Address - Fax:253-929-6244
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA753229374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide