Healthcare Provider Details

I. General information

NPI: 1629114202
Provider Name (Legal Business Name): MERRY ANN GRASSKA N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 MEYER PL NMUSD HOPE CLINIC
COSTA MESA CA
92627
US

IV. Provider business mailing address

24251 PHILEMON DR
DANA POINT CA
92629-1074
US

V. Phone/Fax

Practice location:
  • Phone: 949-515-6725
  • Fax:
Mailing address:
  • Phone: 949-248-0258
  • Fax: 949-248-1704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN 293967 NP8768
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: