Provider Demographics
NPI:1982798260
Name:GRIZZARD, ANNA (CNM)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:GRIZZARD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 ONTARIO RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2627
Mailing Address - Country:US
Mailing Address - Phone:202-483-8196
Mailing Address - Fax:202-483-0836
Practice Address - Street 1:2333 ONTARIO RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2627
Practice Address - Country:US
Practice Address - Phone:202-483-8196
Practice Address - Fax:202-483-0836
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR114638367A00000X
DCRN59767367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
612176400OtherFEDERAL WORKMANS COMP
68596012OtherBCBS
3142241OtherMAMSI
64075OtherAMERIGROUP
0010OtherBCBS
1482782OtherAETNA PPO
MD170550400Medicaid
64075OtherAMERIGROUP