Provider Demographics
NPI:1205423217
Name:GRILLOT, AMY LYNN
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:GRILLOT
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 1:18000 E SHELBY RD
Mailing Address - Street 2:
Mailing Address - City:NEW KNOXVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45871-9535
Mailing Address - Country:US
Mailing Address - Phone:937-726-4882
Mailing Address - Fax:
Practice Address - Street 1:18000 E SHELBY RD
Practice Address - Street 2:
Practice Address - City:NEW KNOXVILLE
Practice Address - State:OH
Practice Address - Zip Code:45871-9535
Practice Address - Country:US
Practice Address - Phone:937-726-4882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker