Provider Demographics
NPI:1861962623
Name:OHRAZDA, GRICELDA
Entity type:Individual
Prefix:
First Name:GRICELDA
Middle Name:
Last Name:OHRAZDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 WALLA WALLA AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-1523
Mailing Address - Country:US
Mailing Address - Phone:509-663-0034
Mailing Address - Fax:509-663-3726
Practice Address - Street 1:1014 WALLA WALLA AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-1523
Practice Address - Country:US
Practice Address - Phone:509-663-0034
Practice Address - Fax:509-663-3726
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1174601611Medicaid