Provider Demographics
NPI:1437442993
Name:GRIESACKER, ANN M (CRNP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:GRIESACKER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 W. LAKE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-3691
Mailing Address - Country:US
Mailing Address - Phone:814-790-4567
Mailing Address - Fax:814-295-4074
Practice Address - Street 1:3250 W. LAKE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-3691
Practice Address - Country:US
Practice Address - Phone:814-454-1085
Practice Address - Fax:814-240-3976
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011370363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily