1477180487 NPI number — MRS. SAMANTHA STEVE GRIGUS RN, BSN

Table of content: MRS. SAMANTHA STEVE GRIGUS RN, BSN (NPI 1477180487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477180487 NPI number — MRS. SAMANTHA STEVE GRIGUS RN, BSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIGUS
Provider First Name:
SAMANTHA
Provider Middle Name:
STEVE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, BSN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEVE
Provider Other First Name:
SAMANTHA
Provider Other Middle Name:
CHRISTINE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, BSN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477180487
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6224 BELLE GROVE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70820-5020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-502-5860
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6224 BELLE GROVE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70820-5020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-502-5860
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2020

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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