Provider Demographics
NPI:1144087842
Name:GOROSPE, DIVINE GRACE (ARNP)
Entity type:Individual
Prefix:
First Name:DIVINE
Middle Name:GRACE
Last Name:GOROSPE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DIVINE GRACE
Other - Middle Name:G
Other - Last Name:GRUBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6824 BEVERLY BLVD EVERETT
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203
Mailing Address - Country:US
Mailing Address - Phone:425-583-7254
Mailing Address - Fax:
Practice Address - Street 1:6824 BEVERLY BLVD EVERETT
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203
Practice Address - Country:US
Practice Address - Phone:425-583-7254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61537026363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily