Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 18010 | NE |
NPI | 1134114424 |
---|---|
Provider Name | Wesley S Grigsby |
First Address | Omaha, NE 68176-0001 |
Second Address | Omaha, NE 68131-2137 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F02126 | (02) |