Provider Demographics
NPI:1184993859
Name:GRUNKEMEIER, RACHNA EAV (PA-C)
Entity type:Individual
Prefix:MRS
First Name:RACHNA
Middle Name:EAV
Last Name:GRUNKEMEIER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 MONTE VILLA PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98041
Mailing Address - Country:US
Mailing Address - Phone:425-288-2105
Mailing Address - Fax:425-288-2106
Practice Address - Street 1:3555 MONTE VILLA PKWY
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98021-8982
Practice Address - Country:US
Practice Address - Phone:425-288-2105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA1004194363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant