Healthcare Provider Details

I. General information

NPI: 1538076294
Provider Name (Legal Business Name): JODY LAINE GRISAMORE MSN, RNC-OB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 S WASHINGTON ST
ELMHURST IL
60126-4348
US

IV. Provider business mailing address

717 S WASHINGTON ST
ELMHURST IL
60126-4348
US

V. Phone/Fax

Practice location:
  • Phone: 630-205-4747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041407283
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: