Provider Demographics
NPI:1124643978
Name:GRANT-DUELL, ROXANNE (HLP)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:GRANT-DUELL
Suffix:
Gender:F
Credentials:HLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6717 159TH ST E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-7417
Mailing Address - Country:US
Mailing Address - Phone:910-987-5798
Mailing Address - Fax:
Practice Address - Street 1:12811 CANYON RD E STE D
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-6301
Practice Address - Country:US
Practice Address - Phone:910-987-5798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4489174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist