Provider Demographics
NPI:1629505862
Name:GRISETTI, JOSEPH ERNEST (NP-C)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ERNEST
Last Name:GRISETTI
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14560 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:FERRUM
Mailing Address - State:VA
Mailing Address - Zip Code:24088-2673
Mailing Address - Country:US
Mailing Address - Phone:540-365-2405
Mailing Address - Fax:
Practice Address - Street 1:13205 BOOKER T WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:HARDY
Practice Address - State:VA
Practice Address - Zip Code:24101-3947
Practice Address - Country:US
Practice Address - Phone:540-719-1815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174938363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000000000000OtherNOTHING