Healthcare Provider Details

I. General information

NPI: 1265171250
Provider Name (Legal Business Name): GRACE LINLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRACE MARY GRABOWSKI PA-C

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22505 ALLEN RD
WOODHAVEN MI
48183-2298
US

IV. Provider business mailing address

22505 ALLEN RD
WOODHAVEN MI
48183-2237
US

V. Phone/Fax

Practice location:
  • Phone: 734-671-6217
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601011118
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: