Provider Demographics
NPI:1437637758
Name:GRIEGO, JUSTEEN A (CNP)
Entity Type:Individual
Prefix:
First Name:JUSTEEN
Middle Name:A
Last Name:GRIEGO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4304 CARLISLE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4811
Mailing Address - Country:US
Mailing Address - Phone:505-888-1075
Mailing Address - Fax:505-888-1082
Practice Address - Street 1:4304 CARLISLE BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4811
Practice Address - Country:US
Practice Address - Phone:505-888-1075
Practice Address - Fax:505-888-1082
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-72666163WH0200X
NM54134363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty