Provider Demographics
NPI:1851434187
Name:GRIESHOP, MARJORIE
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:GRIESHOP
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 1:402 E CLOVER ST
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:KY
Mailing Address - Zip Code:40831-2312
Mailing Address - Country:US
Mailing Address - Phone:606-573-3700
Mailing Address - Fax:606-573-6128
Practice Address - Street 1:402 E CLOVER ST
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:KY
Practice Address - Zip Code:40831-2312
Practice Address - Country:US
Practice Address - Phone:606-573-3700
Practice Address - Fax:606-573-6128
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0306133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0275310Medicare ID - Type Unspecified