Healthcare Provider Details

I. General information

NPI: 1336196997
Provider Name (Legal Business Name): DIABETES CLINICAL SERVICES, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 DANA RD
CRESTWOOD KY
40014-9224
US

IV. Provider business mailing address

PO BOX 6337
LOUISVILLE KY
40206-0337
US

V. Phone/Fax

Practice location:
  • Phone: 502-895-2334
  • Fax:
Mailing address:
  • Phone: 502-895-2334
  • Fax: 502-896-6987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. ELIZABETH M GRABOWSKI
Title or Position: OWNER, PRESIDENT, CLINICAL DIRECTOR
Credential: ARNP
Phone: 502-895-2334