Provider Demographics
NPI:1508601550
Name:GRILLO, ELLEN KATHERINE (PST, CLA 3, MA, EXA)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:KATHERINE
Last Name:GRILLO
Suffix:
Gender:F
Credentials:PST, CLA 3, MA, EXA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 WINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CENTER BARNSTEAD
Mailing Address - State:NH
Mailing Address - Zip Code:03225-3817
Mailing Address - Country:US
Mailing Address - Phone:603-496-2088
Mailing Address - Fax:603-906-2343
Practice Address - Street 1:48 WINWOOD DR
Practice Address - Street 2:
Practice Address - City:CENTER BARNSTEAD
Practice Address - State:NH
Practice Address - Zip Code:03225-3817
Practice Address - Country:US
Practice Address - Phone:603-496-2088
Practice Address - Fax:603-906-2343
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy