Provider Demographics
NPI:1851423750
Name:GRINWIS, BARBARA ANN (MA, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:ANN
Last Name:GRINWIS
Suffix:
Gender:F
Credentials:MA, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 LEONARD ST NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-4258
Mailing Address - Country:US
Mailing Address - Phone:616-451-8868
Mailing Address - Fax:
Practice Address - Street 1:522 LEONARD ST NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-4258
Practice Address - Country:US
Practice Address - Phone:616-451-8868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002045363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical