Provider Demographics
NPI:1093985087
Name:GRIB, NANCY LOU (RN)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:LOU
Last Name:GRIB
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:L
Other - Last Name:ENGLISH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:801 HAZEN STREET
Mailing Address - Street 2:SUITE C PO BOX 249
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-0249
Mailing Address - Country:US
Mailing Address - Phone:269-657-5574
Mailing Address - Fax:269-657-3474
Practice Address - Street 1:52101 34 AVENUE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:MI
Practice Address - Zip Code:49013
Practice Address - Country:US
Practice Address - Phone:269-427-5671
Practice Address - Fax:269-427-1012
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704159460163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse