Provider Demographics
NPI:1659400331
Name:GRILLOT, NANCY DARLENE (NP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:DARLENE
Last Name:GRILLOT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5454 BLUESKY DR
Mailing Address - Street 2:UNIT 15
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-6437
Mailing Address - Country:US
Mailing Address - Phone:513-490-4822
Mailing Address - Fax:
Practice Address - Street 1:5970 KENWOOD RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45243-2930
Practice Address - Country:US
Practice Address - Phone:513-561-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2009-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP06913363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2328903Medicaid
OHGRNP10641Medicare ID - Type Unspecified
OH2328903Medicaid