Provider Demographics
NPI:1851709703
Name:GRIEME, JAMIE L (MNT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:GRIEME
Suffix:
Gender:F
Credentials:MNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2185 FOX AVE
Mailing Address - Street 2:
Mailing Address - City:SCHALLER
Mailing Address - State:IA
Mailing Address - Zip Code:51053-7411
Mailing Address - Country:US
Mailing Address - Phone:712-275-4452
Mailing Address - Fax:
Practice Address - Street 1:1525 W 5TH ST
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-3027
Practice Address - Country:US
Practice Address - Phone:712-732-4030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01747133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered