Healthcare Provider Details

I. General information

NPI: 1144965187
Provider Name (Legal Business Name): SAMUEL PAUL GRANTHAM DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOONE RD
BREMERTON WA
98312-1898
US

IV. Provider business mailing address

4301 JONES BRIDGE RD
BETHESDA MD
20814-4799
US

V. Phone/Fax

Practice location:
  • Phone: 360-475-4000
  • Fax:
Mailing address:
  • Phone: 301-295-9004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number325562
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: