Provider Demographics
NPI:1265605158
Name:GRIESHABER, EMILY KATHERINE (MD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:KATHERINE
Last Name:GRIESHABER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 W 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-2422
Mailing Address - Country:US
Mailing Address - Phone:985-893-1035
Mailing Address - Fax:985-893-1058
Practice Address - Street 1:714 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2422
Practice Address - Country:US
Practice Address - Phone:985-893-1035
Practice Address - Fax:985-893-1058
Is Sole Proprietor?:No
Enumeration Date:2008-04-11
Last Update Date:2012-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LAMD.203353207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program