Provider Demographics
NPI:1730662057
Name:GRODS, HEATHER RENEE (ARNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENEE
Last Name:GRODS
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 1:4409 CALIFORNIA AVE SW STE 100
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4916
Mailing Address - Country:US
Mailing Address - Phone:206-228-7281
Mailing Address - Fax:
Practice Address - Street 1:4409 CALIFORNIA AVE SW STE 100
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4916
Practice Address - Country:US
Practice Address - Phone:206-228-7281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60894966363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP60894966OtherMEDICAL SPA