Provider Demographics
NPI:1083692206
Name:GRYMES CHAPMAN, GRACE C (DNP)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:C
Last Name:GRYMES CHAPMAN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5188
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-5188
Mailing Address - Country:US
Mailing Address - Phone:855-229-6460
Mailing Address - Fax:
Practice Address - Street 1:3507 SW HENDERSON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-3852
Practice Address - Country:US
Practice Address - Phone:206-701-4271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201807234NP-PP363LF0000X
MT170561363LF0000X
AK168109363LF0000X
WAAP30006867363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9649997Medicaid
WA8864106Medicare UPIN