Provider Demographics
NPI:1336742782
Name:GRIESHOP, LUKE ANTHONY
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:ANTHONY
Last Name:GRIESHOP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E 3RD ST APT 411
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-5106
Mailing Address - Country:US
Mailing Address - Phone:419-953-2646
Mailing Address - Fax:
Practice Address - Street 1:151 N MUMAUGH RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-3527
Practice Address - Country:US
Practice Address - Phone:419-953-2646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide