Provider Demographics
NPI:1407321136
Name:ANNIE GRUMMEL, LLC
Entity Type:Organization
Organization Name:ANNIE GRUMMEL, LLC
Other - Org Name:ANN GRUMMEL WARD, PMHNP
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:GRUMMEL
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:503-894-9810
Mailing Address - Street 1:758 NW POWHATAN TER
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2731
Mailing Address - Country:US
Mailing Address - Phone:503-706-9791
Mailing Address - Fax:
Practice Address - Street 1:2187 SW MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1123
Practice Address - Country:US
Practice Address - Phone:503-894-9810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty