Provider Demographics
NPI:1508547738
Name:GREWAL, NEHA
Entity Type:Individual
Prefix:
First Name:NEHA
Middle Name:
Last Name:GREWAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45646 TORCH LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-4247
Mailing Address - Country:US
Mailing Address - Phone:586-746-9532
Mailing Address - Fax:
Practice Address - Street 1:6832 CONVENT BLVD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-4805
Practice Address - Country:US
Practice Address - Phone:800-878-3210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH505709163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse