Provider Demographics
NPI:1750415675
Name:GRIEME, ANGELICA
Entity type:Individual
Prefix:MRS
First Name:ANGELICA
Middle Name:
Last Name:GRIEME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 PETERSON ST
Mailing Address - Street 2:
Mailing Address - City:ALTA
Mailing Address - State:IA
Mailing Address - Zip Code:51002-1350
Mailing Address - Country:US
Mailing Address - Phone:712-299-1281
Mailing Address - Fax:712-200-1633
Practice Address - Street 1:620 MICHIGAN ST
Practice Address - Street 2:COLONIAL ARCADE, SUITE#6
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-1800
Practice Address - Country:US
Practice Address - Phone:712-732-4322
Practice Address - Fax:712-732-4322
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03510225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist