Provider Demographics
NPI:1639117328
Name:GRIGUTIS, EILEEN O'NEIL (ARNP)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:O'NEIL
Last Name:GRIGUTIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:501 E BROADWAY
Mailing Address - Street 2:STE 290
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1785
Mailing Address - Country:US
Mailing Address - Phone:502-217-8221
Mailing Address - Fax:502-217-5056
Practice Address - Street 1:550 S JACKSON ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1622
Practice Address - Country:US
Practice Address - Phone:502-562-6511
Practice Address - Fax:502-562-6512
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2015-11-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY3333P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200942760Medicaid
KY536489OtherANTHEM
KY7100049340Medicaid
KY50016607OtherPASSPORT HEALTH PLAN
KY00243022Medicare PIN