Provider Demographics
NPI:1851321509
Name:GRISCHO, DEBORAH R (FNPC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:R
Last Name:GRISCHO
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 S COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-9701
Mailing Address - Country:US
Mailing Address - Phone:489-505-0500
Mailing Address - Fax:
Practice Address - Street 1:1440 S COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-9701
Practice Address - Country:US
Practice Address - Phone:489-505-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN-044184363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ75555Medicare ID - Type Unspecified
AZP78780Medicare UPIN