Doctor Name: | CHRISTINE R GRISSUM |
NPI Number: | 1386972925 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | A.N.P. |
License Number: | 143038 |
Business Practice Address: | 13655 Riverport Dr Maryland Heights, MO - 630434812 |
Business Phone Number: | 3145927055 |
Business Fax Number: | |
Mailing Address: | 13655 Riverport Dr, MARYLAND HEIGHTS |
State: | MO |
Postal Code: | 630434812 |
Phone Number: | 3145927055 |
Fax Number: | |
NPI Enumeration Date: | 11/19/2009 |
NPI Last Update Date: | 07/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | 143038 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |