Provider Demographics
NPI:1912367087
Name:GRIGSBY, MICHAEL VERNE (MA, RN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:VERNE
Last Name:GRIGSBY
Suffix:
Gender:M
Credentials:MA, RN
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:VERNE
Other - Last Name:GRIGSBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, RN
Mailing Address - Street 1:4002 W QUINN PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80236-3523
Mailing Address - Country:US
Mailing Address - Phone:303-324-2432
Mailing Address - Fax:
Practice Address - Street 1:1290 S POTOMAC ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4524
Practice Address - Country:US
Practice Address - Phone:303-745-1281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1619787163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO163WP0807XOtherNPI