Healthcare Provider Details

I. General information

NPI: 1023780384
Provider Name (Legal Business Name): ELISE GRISET CPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 UNION BLVD STE 440
LAKEWOOD CO
80228-1812
US

IV. Provider business mailing address

200 UNION BLVD STE 440
LAKEWOOD CO
80228-1812
US

V. Phone/Fax

Practice location:
  • Phone: 720-417-8698
  • Fax:
Mailing address:
  • Phone: 720-417-8698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO04294
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: