Provider Demographics
NPI:1396860375
Name:GRANT, DEBRA FRAZIER (ARNP)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:FRAZIER
Last Name:GRANT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10515 497TH ST E
Mailing Address - Street 2:
Mailing Address - City:EATONVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98328-9458
Mailing Address - Country:US
Mailing Address - Phone:360-569-2509
Mailing Address - Fax:360-832-3661
Practice Address - Street 1:207 CENTER ST E
Practice Address - Street 2:
Practice Address - City:EATONVILLE
Practice Address - State:WA
Practice Address - Zip Code:98328
Practice Address - Country:US
Practice Address - Phone:360-832-2167
Practice Address - Fax:360-832-3661
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001917363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9604174Medicaid
WA7900616Medicaid