Provider Demographics
NPI:1760647796
Name:GRIESBACH, DIANE L (RNC ANP)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:L
Last Name:GRIESBACH
Suffix:
Gender:F
Credentials:RNC ANP
Other - Prefix:
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Mailing Address - Street 1:24 MEETINGHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-2371
Mailing Address - Country:US
Mailing Address - Phone:978-975-4257
Mailing Address - Fax:978-749-4469
Practice Address - Street 1:180 MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-4166
Practice Address - Country:US
Practice Address - Phone:978-749-4455
Practice Address - Fax:978-749-4469
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA188915363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health