Provider Demographics
NPI:1336305150
Name:GRISWOLD, NATHAN DAVID (PAC)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:DAVID
Last Name:GRISWOLD
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Gender:M
Credentials:PAC
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Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 MICHIGAN ST NE
Practice Address - Street 2:SUITE 8830
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2560
Practice Address - Country:US
Practice Address - Phone:616-459-7258
Practice Address - Fax:616-459-5215
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2022-10-25
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Provider Licenses
StateLicense IDTaxonomies
MI5601005279363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant