Provider Demographics
NPI:1013745876
Name:GRIESHOP, ELLEN DOLORES
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:DOLORES
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 1:8055 STUCK RD
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:OH
Mailing Address - Zip Code:45380-9458
Mailing Address - Country:US
Mailing Address - Phone:937-638-0925
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 85
Practice Address - Street 2:
Practice Address - City:NORTH STAR
Practice Address - State:OH
Practice Address - Zip Code:45350-0085
Practice Address - Country:US
Practice Address - Phone:937-423-1894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty