Provider Demographics
NPI:1851971808
Name:GRISSETT, IMANI
Entity Type:Individual
Prefix:
First Name:IMANI
Middle Name:
Last Name:GRISSETT
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 1:1426 SHADY GLEN DR
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-1714
Mailing Address - Country:US
Mailing Address - Phone:240-707-4337
Mailing Address - Fax:
Practice Address - Street 1:3600 B ST SE APT 302
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-7326
Practice Address - Country:US
Practice Address - Phone:202-276-9797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant