Provider Demographics
NPI:1174001689
Name:GRISBY, YOLANDA D
Entity Type:Individual
Prefix:MS
First Name:YOLANDA
Middle Name:D
Last Name:GRISBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 73462
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70874-3462
Mailing Address - Country:US
Mailing Address - Phone:225-281-7991
Mailing Address - Fax:
Practice Address - Street 1:9255 CEDAR GLEN DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70811-2304
Practice Address - Country:US
Practice Address - Phone:225-281-7991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver