Healthcare Provider Details

I. General information

NPI: 1780509083
Provider Name (Legal Business Name): MELINDA GRIESEMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4973 AQUADUCT DR
GREENWOOD IN
46142-7536
US

IV. Provider business mailing address

4973 AQUADUCT DR
GREENWOOD IN
46142-7536
US

V. Phone/Fax

Practice location:
  • Phone: 317-657-7703
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRNP344155
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: