Healthcare Provider Details

I. General information

NPI: 1598815599
Provider Name (Legal Business Name): JEAN CAREY GRIESEL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 1ST ST NW
BRITT IA
50423-2607
US

IV. Provider business mailing address

1005 WISCONSIN AVE
BOSCOBEL WI
53805
US

V. Phone/Fax

Practice location:
  • Phone: 641-843-5067
  • Fax: 641-843-5001
Mailing address:
  • Phone: 712-592-1327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number55094-021
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02716
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: