MEDICARE: HALLIE GRANVILLE ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP70020788	WA
2	367A00000X	Advanced Practice Midwife	AP61012020	WA

General Provider Information

NPI Number	:	1649814658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALLIE GRANVILLE ARNP

Provider Business Mailing Address
First Line	:	307 N OLYMPIC AVE STE 206
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-1351
Country	:	US
Telephone Number	:	360-229-5954
Fax Number	:	360-200-0463

Provider Business Practice Location Address
First Line	:	307 N OLYMPIC AVE STE 206
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-1351
Country	:	US
Telephone Number	:	360-229-5954
Fax Number	:	360-200-0463

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2019
Last Update Date	:	02/21/2026

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