Provider Demographics
NPI:1073390118
Name:GRIESHOP, PHYLLIS ANN
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:ANN
Last Name:GRIESHOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:OH
Mailing Address - Zip Code:45828-9611
Mailing Address - Country:US
Mailing Address - Phone:419-790-8047
Mailing Address - Fax:
Practice Address - Street 1:415 4TH AVE
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:OH
Practice Address - Zip Code:45828-9611
Practice Address - Country:US
Practice Address - Phone:419-790-8047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant