Provider Demographics
NPI:1780894766
Name:GRANGER, THERESA ANNE (ARNP)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:ANNE
Last Name:GRANGER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:THERESA
Other - Middle Name:ANNE
Other - Last Name:ORR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:540 N WEST AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-1251
Mailing Address - Country:US
Mailing Address - Phone:360-435-8282
Mailing Address - Fax:360-474-1394
Practice Address - Street 1:540 N WEST AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1251
Practice Address - Country:US
Practice Address - Phone:360-435-8282
Practice Address - Fax:360-474-1394
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004053363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily