Healthcare Provider Details

I. General information

NPI: 1205416088
Provider Name (Legal Business Name): ANNALISE DORIS GRAMMERSTORF PA-C, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 S QUEBEC ST STE 312A
GREENWOOD VILLAGE CO
80111-2208
US

IV. Provider business mailing address

5600 S QUEBEC ST STE 312A
GREENWOOD VILLAGE CO
80111-2208
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-2727
  • Fax:
Mailing address:
  • Phone: 303-436-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0007448
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: