Provider Demographics
NPI:1598732638
Name:GRIGSBY, JENNIFER B (CRNA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:B
Last Name:GRIGSBY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:B
Other - Last Name:GRIGSBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSN RN MS CRNA
Mailing Address - Street 1:2555 W CAMPO ALEGRE CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-5465
Mailing Address - Country:US
Mailing Address - Phone:480-699-0299
Mailing Address - Fax:
Practice Address - Street 1:2555 W CAMPO ALEGRE CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-5465
Practice Address - Country:US
Practice Address - Phone:480-699-0299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCRNA0735367500000X
MI4704160901367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI430F364420OtherBCBSM
MI2758044Medicaid
MI430F364420OtherBCBSM
MIR67591Medicare UPIN
MIR67591Medicare UPIN