Healthcare Provider Details

I. General information

NPI: 1235620378
Provider Name (Legal Business Name): BRIANNA ELIZABETH GRINNELL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 UNION BAY PL NE
SEATTLE WA
98105-4025
US

IV. Provider business mailing address

PO BOX 25608
SALT LAKE CITY UT
84125-0608
US

V. Phone/Fax

Practice location:
  • Phone: 206-320-8050
  • Fax: 206-320-8048
Mailing address:
  • Phone: 206-320-4476
  • Fax: 206-568-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP61078848
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: