Provider Demographics
NPI:1750001962
Name:GRIMES, ADRIANA SUSANNA (PA-C)
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:SUSANNA
Last Name:GRIMES
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 1:1980 SE MORRISON ST APT 406
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2574
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 N GRAHAM ST STE 445
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-2002
Practice Address - Country:US
Practice Address - Phone:503-944-6300
Practice Address - Fax:503-413-4470
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA217811363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant