Provider Demographics
NPI:1831389220
Name:GRISSO, RIKKI REANE (LVN)
Entity type:Individual
Prefix:MRS
First Name:RIKKI
Middle Name:REANE
Last Name:GRISSO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:RIKKI
Other - Middle Name:REANE
Other - Last Name:GRISSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:208 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-3226
Mailing Address - Country:US
Mailing Address - Phone:909-967-6731
Mailing Address - Fax:
Practice Address - Street 1:208 DAVIS ST
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-3226
Practice Address - Country:US
Practice Address - Phone:909-967-6731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN227032164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse