Healthcare Provider Details

I. General information

NPI: 1003293754
Provider Name (Legal Business Name): JENNIFER LEIGH GRIESEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date: 02/13/2026
Reactivation Date: 03/13/2026

III. Provider practice location address

1 JARRETT WHITE RD
TRIPLER ARMY MEDICAL CENTER HI
96859-5001
US

IV. Provider business mailing address

PO BOX 649
FORT DEFIANCE AZ
86504-0649
US

V. Phone/Fax

Practice location:
  • Phone: 888-683-2778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberBP10053125
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: