Provider Demographics
NPI:1083117618
Name:MITRE, GRIZELLE CALABIA (NURSE)
Entity Type:Individual
Prefix:
First Name:GRIZELLE
Middle Name:CALABIA
Last Name:MITRE
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 OLD TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2532
Mailing Address - Country:US
Mailing Address - Phone:845-499-6120
Mailing Address - Fax:
Practice Address - Street 1:20 OLD TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2532
Practice Address - Country:US
Practice Address - Phone:646-709-7374
Practice Address - Fax:646-709-7374
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-09
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY329447164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse