Provider Demographics
NPI:1316376064
Name:GRIESS, GARY L (LPN)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:L
Last Name:GRIESS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 SW PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-3624
Mailing Address - Country:US
Mailing Address - Phone:360-352-3302
Mailing Address - Fax:360-748-8767
Practice Address - Street 1:1265 SW PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-3624
Practice Address - Country:US
Practice Address - Phone:360-352-3302
Practice Address - Fax:360-748-8767
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00054336164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse