Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 86-239 | NM |
NPI | 1033568902 |
---|---|
Provider Name | Dr. Karen Griest |
First Address | Cedar Crest, NM 87008-9444 |
Second Address | Cedar Crest, NM 87008-9444 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2016 |
Last Update Date | 10/06/2016 |