Provider Demographics
NPI:1164126181
Name:GRIGSON, MARY LEE (APNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LEE
Last Name:GRIGSON
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LEE
Other - Last Name:DAUBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1020 HILL ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53098-3016
Mailing Address - Country:US
Mailing Address - Phone:844-206-4930
Mailing Address - Fax:920-261-7327
Practice Address - Street 1:1020 HILL ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53098-3016
Practice Address - Country:US
Practice Address - Phone:844-206-4930
Practice Address - Fax:920-261-7327
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13731-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily