Healthcare Provider Details

I. General information

NPI: 1871921213
Provider Name (Legal Business Name): DIANE E GRISE N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2013
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2164 E BROADWAY RD
TEMPE AZ
85282-1766
US

IV. Provider business mailing address

2406 E LA JOLLA DR
TEMPE AZ
85282-6019
US

V. Phone/Fax

Practice location:
  • Phone: 480-970-0000
  • Fax:
Mailing address:
  • Phone: 812-614-4441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number13-1398
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: