1346391273 NPI number — SUSAN K GRIGSBY RN, MSN, NP-C, CHPN

Table of content: SUSAN K GRIGSBY RN, MSN, NP-C, CHPN (NPI 1346391273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346391273 NPI number — SUSAN K GRIGSBY RN, MSN, NP-C, CHPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIGSBY
Provider First Name:
SUSAN
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, MSN, NP-C, CHPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346391273
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1050 STATE HIGHWAY 16 S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BANDERA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78003-4830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-796-7713
Provider Business Mailing Address Fax Number:
830-796-7744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1050 HWY 16 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BANDERA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78003-4830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-796-7713
Provider Business Practice Location Address Fax Number:
830-796-7744
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LG0600X , with the licence number:  2006010375 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 689000 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6890000 . This is a "RN BOARD OF EXAM" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2006010375 . This is a "GERONTOLOGICAL NURSE PRAC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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