| Doctor Name: | BONNIE J GRISSOM |
| NPI Number: | 1003016650 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | 64034 |
| Business Practice Address: | Palmetto Health Baptist Diabetes Education 1333 Taylor Street; Suite 4-e Columbia, SC - 29201 |
| Business Phone Number: | 8032963956 |
| Business Fax Number: | 8032968908 |
| Mailing Address: | Palmetto Health Baptist Diabetes Education, 1333 Taylor Street; Suite 4-e COLUMBIA |
| State: | SC |
| Postal Code: | 29201 |
| Phone Number: | 8032963956 |
| Fax Number: | 8032968908 |
| NPI Enumeration Date: | 07/23/2007 |
| NPI Last Update Date: | 07/23/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WD0400X |
| License Number: | 64034 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Diabetes Educator |
| Taxonomy Definition: | |