Provider Demographics
NPI:1790556504
Name:GRIEDER, KIM LAVELL
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:LAVELL
Last Name:GRIEDER
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 1:8314 WINDING WOOD DR
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-3062
Mailing Address - Country:US
Mailing Address - Phone:973-219-2738
Mailing Address - Fax:
Practice Address - Street 1:8314 WINDING WOOD DR
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-3062
Practice Address - Country:US
Practice Address - Phone:973-219-2738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider