Provider Demographics
NPI:1578638953
Name:GRISHAM, KAREN E (PSYCHIATRIC MENTAL H)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:GRISHAM
Suffix:
Gender:F
Credentials:PSYCHIATRIC MENTAL H
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 COMMERCIAL ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5203
Mailing Address - Country:US
Mailing Address - Phone:503-363-1422
Mailing Address - Fax:503-362-3310
Practice Address - Street 1:1845 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-5203
Practice Address - Country:US
Practice Address - Phone:503-363-1422
Practice Address - Fax:503-362-3310
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000025769N6 PMHNP PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR106174Medicare PIN