Provider Demographics
NPI:1649408949
Name:GRISHAM, CASEY
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:GRISHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 W MARINE VIEW DR
Mailing Address - Street 2:BLDG 2134
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98207-0001
Mailing Address - Country:US
Mailing Address - Phone:425-304-4790
Mailing Address - Fax:425-304-4798
Practice Address - Street 1:2000 W MARINE VIEW DR
Practice Address - Street 2:BLDG 2134
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98207-0001
Practice Address - Country:US
Practice Address - Phone:425-304-4790
Practice Address - Fax:425-304-4798
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant