Healthcare Provider Details

I. General information

NPI: 1386173524
Provider Name (Legal Business Name): ANNA GRACE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA GRACE ADAMCZYK

II. Dates (important events)

Enumeration Date: 06/10/2017
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 TALLMAN AVE NW STE 520
SEATTLE WA
98107-5910
US

IV. Provider business mailing address

PO BOX 25608
SALT LAKE CITY UT
84125-0608
US

V. Phone/Fax

Practice location:
  • Phone: 206-215-1770
  • Fax: 206-215-1771
Mailing address:
  • Phone: 206-320-4476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61252446
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: