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General NPI Number Information
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NPI Number | 1710908264
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Entity Type | Individual
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Provider Name | GRACE P. LANDEL PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 4245 ROOSEVELT WAY NE BOX 354770
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City | SEATTLE
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State | WA
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Zip | 98105-6008
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Country | US
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Telephone | 206-598-4055
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Fax | 206-598-5720
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Provider Business Mailing Address
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Address Line | PO BOX 24366 M/S 359107
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City | SEATTLE
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State | WA
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Zip | 98124-0366
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Country | US
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Telephone | 206-598-8920
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Fax | 206-598-7663
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA10001588
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License Number State | WA
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