Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 0103301207 | VA |
N | 222Z00000X | Podiatrist | 0103301207 | VA |
N | 213EP0504X | Public Medicine | 0103301207 | VA |
N | 213EP1101X | Primary Podiatric Medicine | 0103301207 | VA |
Y | 213EP1101X | Primary Podiatric Medicine | EL07440 | NH |
N | 2081S0010X | Sports Medicine | 0103301207 | VA |
N | 213ES0000X | Sports Medicine | 0103301207 | VA |
N | 213ES0103X | Foot & Ankle Surgery | 0103301207 | VA |
N | 213ES0103X | Foot & Ankle Surgery | EL07440 | NH |
N | 213ES0131X | Foot Surgery | 0103301207 | VA |
NPI | 1083816961 |
---|---|
Provider Name | Dr. Faye-Rose Grebenyuk |
First Address | Columbus, GA 31904-4970 |
Second Address | Columbus, GA 31904-4970 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2007 |
Last Update Date | 21/09/2021 |