Provider Demographics
NPI:1265982870
Name:GRISSMAN, ERIN (RT(R)(ARRT))
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:GRISSMAN
Suffix:
Gender:F
Credentials:RT(R)(ARRT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 VENUS ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-7753
Mailing Address - Country:US
Mailing Address - Phone:806-773-4999
Mailing Address - Fax:
Practice Address - Street 1:3260 VENUS ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-7753
Practice Address - Country:US
Practice Address - Phone:806-773-4999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM461593247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist