Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 134726 | MO |
N | 363LP2300X | Nurse Practitioner - Primary Care | 71003082 | IN |
NPI | 1013029552 |
---|---|
Provider Name | Rosanne R Griggs |
First Address | Fairview Heights, IL 62208-3611 |
Second Address | Wolcott, IN 47995-8130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 30/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (02) | MO |