Provider Demographics
NPI:1720097017
Name:GRISWOLD, DELIGHT J (NP MSN APN BC)
Entity Type:Individual
Prefix:MS
First Name:DELIGHT
Middle Name:J
Last Name:GRISWOLD
Suffix:
Gender:F
Credentials:NP MSN APN BC
Other - Prefix:MS
Other - First Name:DELIGHT
Other - Middle Name:JANE
Other - Last Name:GRISWOLD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSNAPN,BC
Mailing Address - Street 1:PO BOX 3407
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47733-3407
Mailing Address - Country:US
Mailing Address - Phone:812-450-3405
Mailing Address - Fax:812-450-3099
Practice Address - Street 1:600 MARY ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1674
Practice Address - Country:US
Practice Address - Phone:812-450-3405
Practice Address - Fax:812-450-3099
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003905A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ95961ZOtherBLUE SHIELD WFP
CAFHC03843FMedicaid
CAFHC70292FMedicaid
ZZZ42576ZOtherBLUE SHIELD DFP
ZZZ87615ZOtherNHC
CAFHC70081FMedicaid
ZZZ87615ZOtherNHC
Q56036Medicare UPIN
CAFHC03843FMedicaid
051947Medicare ID - Type UnspecifiedDFP
051008Medicare ID - Type UnspecifiedNHC
IL817440Medicare Oscar/Certification