Basic Information
| Provider Information | |||||||||
| NPI: | 1326548959 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRISHAM | ||||||||
| FirstName: | JERRI | ||||||||
| MiddleName: | SUZETTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1127 W 4TH ST | ||||||||
| Address2: | |||||||||
| City: | LITTLEFIELD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 793393003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063851009 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3708 20TH ST | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794101228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067448999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2018 | ||||||||
| LastUpdateDate: | 02/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 674472 | TX | Y | Nursing Service Providers | Registered Nurse |
No ID Information.