Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 0101262085 | VA |
N | 2080P0204X | Pediatric Emergency Doctor | D63821 | MD |
NPI | 1114129608 |
---|---|
Provider Name | Dr. Stephanie Elaine Griese |
First Address | Hampton, VA 23669-1095 |
Second Address | Norfolk, VA 23507-1910 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036668400 | (05) | MD |