Provider Demographics
NPI:1912034562
Name:GRILLS, MICHAEL (RN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GRILLS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 N PINE RD
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-1917
Mailing Address - Country:US
Mailing Address - Phone:989-892-5732
Mailing Address - Fax:
Practice Address - Street 1:1215 N PINE RD
Practice Address - Street 2:
Practice Address - City:ESSEXVILLE
Practice Address - State:MI
Practice Address - Zip Code:48732-1917
Practice Address - Country:US
Practice Address - Phone:989-892-5732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704191815163WH0200X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WH0200XNursing Service ProvidersRegistered NurseHome Health
Not Answered163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health