Provider Demographics
NPI:1538186457
Name:GRINNELL, PATRICIA LYNN (NP)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:LYNN
Last Name:GRINNELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LYNCH CREEK WAY STE A
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-2337
Mailing Address - Country:US
Mailing Address - Phone:707-763-0600
Mailing Address - Fax:707-765-1757
Practice Address - Street 1:110 LYNCH CREEK WAY STE A
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-2337
Practice Address - Country:US
Practice Address - Phone:707-763-0600
Practice Address - Fax:707-765-1757
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA397558363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN397558Medicaid
Q70510Medicare UPIN