Healthcare Provider Details

I. General information

NPI: 1619753753
Provider Name (Legal Business Name): LASCELLE CLARENCE GRIZZLE REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date: 04/10/2024
Reactivation Date: 11/05/2025

III. Provider practice location address

1959 NE PACIFIC STREET T-301
SEATTLE WA
98195-7263
US

IV. Provider business mailing address

1959 NE PACIFIC STREET T-301
SEATTLE WA
98195-7263
US

V. Phone/Fax

Practice location:
  • Phone: 253-287-0670
  • Fax:
Mailing address:
  • Phone: 253-287-0670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP.AP.70143005-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: