Provider Demographics
NPI:1083032197
Name:GRIPPON, NATHALIE JULIENNE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:NATHALIE
Middle Name:JULIENNE
Last Name:GRIPPON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W HARGETT ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27601-1700
Mailing Address - Country:US
Mailing Address - Phone:984-255-2107
Mailing Address - Fax:
Practice Address - Street 1:605 W CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-4823
Practice Address - Country:US
Practice Address - Phone:910-891-1391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04792363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant