Provider Demographics
NPI:1780086025
Name:GRIESS, JULIE LALENA (CNA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:LALENA
Last Name:GRIESS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2964 NE DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-3726
Mailing Address - Country:US
Mailing Address - Phone:541-680-2008
Mailing Address - Fax:
Practice Address - Street 1:2964 NE DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3726
Practice Address - Country:US
Practice Address - Phone:541-680-2008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR261QP0904X261QP0904X
OR261QV0200X261QV0200X
OR314000000X314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA