Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Grace Lake

Individual provider Physician Assistant · NPI 1124752233

Grace Lake is a Physician Assistant in Newport, Oregon. Licensed in Oregon. Registered with an NPI since 2022.

Licensed in
OR
In the registry since
2022

Practice location Address checks out

930 SW Abbey St
Newport, OR 97365-4820
Phone: (541) 265-2244
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA221993 (OR)

Record details

NPI number1124752233
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJuly 13, 2022
Last updated in NPPESNovember 8, 2024
Certification dateNovember 8, 2024
Mailing address930 Sw Abbey St, Newport, OR 97365-4820

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