Provider Demographics
NPI:1417930314
Name:GRASMICK, CHERYL A (PA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:GRASMICK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 MAXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-3972
Mailing Address - Country:US
Mailing Address - Phone:303-544-5783
Mailing Address - Fax:303-441-2388
Practice Address - Street 1:1755 48TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2711
Practice Address - Country:US
Practice Address - Phone:303-494-5263
Practice Address - Fax:303-494-5265
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0000620363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1024699OtherNCCPA
CO96503548Medicaid
COCOA106745Medicare PIN
CO1024699OtherNCCPA