Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AO1678 | AR |
N | 363LN0000X | Nurse Practitioner - Neonatal | R62819 | AR |
NPI | 1023240744 |
---|---|
Provider Name | Scott Grigg |
First Address | Springdale, AR 72762-8701 |
Second Address | Springdale, AR 72762-8701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2009 |
Last Update Date | 30/01/2013 |