Provider Demographics
NPI:1639761950
Name:GRIECO, DELORIS
Entity Type:Individual
Prefix:
First Name:DELORIS
Middle Name:
Last Name:GRIECO
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 1:3375 WOODVILLE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-5231
Mailing Address - Country:US
Mailing Address - Phone:304-840-8381
Mailing Address - Fax:
Practice Address - Street 1:3375 WOODVILLE DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-5231
Practice Address - Country:US
Practice Address - Phone:304-840-8381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker