Provider Demographics
NPI:1790972255
Name:GRIEWING, CANDICE (APN)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:GRIEWING
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 S HIGHWAY 94
Mailing Address - Street 2:STE 202
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5677
Mailing Address - Country:US
Mailing Address - Phone:636-939-4200
Mailing Address - Fax:
Practice Address - Street 1:2730 S HIGHWAY 94
Practice Address - Street 2:STE 202
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63303-5677
Practice Address - Country:US
Practice Address - Phone:636-939-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO128905363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO128905OtherSTATE LICENSE