Provider Demographics
NPI:1255732327
Name:GRISSOM, ERICA CORRINE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:CORRINE
Last Name:GRISSOM
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Gender:F
Credentials:CRNA
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Mailing Address - Street 1:50 N DUNLAP ST
Mailing Address - Street 2:2ND FLOOR CHILDREN'S RESEARCH FOUNDATION TOWER
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2800
Mailing Address - Country:US
Mailing Address - Phone:901-287-6060
Mailing Address - Fax:901-287-5102
Practice Address - Street 1:50 N DUNLAP ST
Practice Address - Street 2:2ND FLOOR CHILDREN'S RESEARCH FOUNDATION TOWER
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2800
Practice Address - Country:US
Practice Address - Phone:901-287-6060
Practice Address - Fax:901-287-5102
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2025-05-15
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Provider Licenses
StateLicense IDTaxonomies
TN168625163W00000X
TN19197367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse