Provider Demographics
NPI:1851431290
Name:GRIPSHOVER, JANET (CRNP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:GRIPSHOVER
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 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 UCLA MEDICAL PLZ STE 214
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-7900
Practice Address - Country:US
Practice Address - Phone:310-794-7788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018905363L00000X
MDR172924363LF0000X
CA95021316363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD419998700Medicaid
MDS062-0410OtherBLUE CROSS/BLUE SHIELD - REGIONAL
MD950877-01OtherBLUE CROSS/BLUE SHIELD
MDS062-0410OtherBLUE CROSS/BLUE SHIELD - REGIONAL
MD950877-01OtherBLUE CROSS/BLUE SHIELD