Provider Demographics
NPI:1134699325
Name:GREVIOUS, EDITH LOVETTE (MASTERS PUBLIC HLTH)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:LOVETTE
Last Name:GREVIOUS
Suffix:
Gender:F
Credentials:MASTERS PUBLIC HLTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1648 TERRYS MOUNTAIN RD APT 2
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-8615
Mailing Address - Country:US
Mailing Address - Phone:919-809-0403
Mailing Address - Fax:
Practice Address - Street 1:1648 TERRYS MOUNTAIN RD APT 2
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-8615
Practice Address - Country:US
Practice Address - Phone:919-809-0403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program