Provider Demographics
NPI:1174287445
Name:GRIER, TATIANA (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:TATIANA
Middle Name:
Last Name:GRIER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:TATIANA
Other - Middle Name:
Other - Last Name:FUNCHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2800 S CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-5107
Mailing Address - Country:US
Mailing Address - Phone:773-674-7703
Mailing Address - Fax:
Practice Address - Street 1:1S450 SUMMIT AVE STE 310
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-3977
Practice Address - Country:US
Practice Address - Phone:608-763-7560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-23
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.023602363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner