Provider Demographics
NPI:1386044832
Name:GRIEDER, MARY J (APRN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:GRIEDER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WILLOW AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-0807
Mailing Address - Country:US
Mailing Address - Phone:712-256-4420
Mailing Address - Fax:712-256-4423
Practice Address - Street 1:500 WILLOW AVE STE 305
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-0807
Practice Address - Country:US
Practice Address - Phone:712-256-4420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2021-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112377363LF0000X
IAA083627363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily