Provider Demographics
NPI:1790901536
Name:GRIESBACH, DANA BARLOW (CRNP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:BARLOW
Last Name:GRIESBACH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 LOOP RD
Mailing Address - Street 2:TUSCALOOSA VA MEDICAL CENTER
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-5015
Mailing Address - Country:US
Mailing Address - Phone:205-554-2822
Mailing Address - Fax:205-554-2894
Practice Address - Street 1:3701 LOOP RD
Practice Address - Street 2:TUSCALOOSA VA MEDICAL CENTER
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-5015
Practice Address - Country:US
Practice Address - Phone:205-554-2822
Practice Address - Fax:205-554-2894
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-045884363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051550782GRIMedicare ID - Type Unspecified
ALP35067Medicare UPIN