Provider Demographics
NPI:1629114202
Name:GRASSKA, MERRY ANN (NP)
Entity Type:Individual
Prefix:
First Name:MERRY
Middle Name:ANN
Last Name:GRASSKA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24251 PHILEMON DR
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-1074
Mailing Address - Country:US
Mailing Address - Phone:949-248-0258
Mailing Address - Fax:949-248-1704
Practice Address - Street 1:2045 MEYER PL
Practice Address - Street 2:NMUSD HOPE CLINIC
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627
Practice Address - Country:US
Practice Address - Phone:949-515-6725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 293967 NP8768363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily