Provider Demographics
NPI:1295750990
Name:GRANDY, ADITI M (CNM, ARNP)
Entity type:Individual
Prefix:MS
First Name:ADITI
Middle Name:M
Last Name:GRANDY
Suffix:
Gender:F
Credentials:CNM, ARNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:M
Other - Last Name:GRANDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, ARNP
Mailing Address - Street 1:10330 MERIDIAN AVE N
Mailing Address - Street 2:SUITE 190
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9451
Mailing Address - Country:US
Mailing Address - Phone:206-368-6670
Mailing Address - Fax:206-368-6171
Practice Address - Street 1:10330 MERIDIAN AVE N
Practice Address - Street 2:BOX 356460
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133
Practice Address - Country:US
Practice Address - Phone:206-368-6670
Practice Address - Fax:206-368-6171
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00092243163W00000X
WAAP30003952363L00000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9638099Medicaid
S28365Medicare UPIN
WA9638099Medicaid