Provider Demographics
NPI:1659816312
Name:GRIESHEIMER, ERIC (CRNA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:GRIESHEIMER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9924 FORESTGLEN DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5116
Mailing Address - Country:US
Mailing Address - Phone:615-584-3343
Mailing Address - Fax:
Practice Address - Street 1:9924 FORESTGLEN DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-5116
Practice Address - Country:US
Practice Address - Phone:615-584-3343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH019390367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered