Healthcare Provider Details

I. General information

NPI: 1639117328
Provider Name (Legal Business Name): EILEEN O'NEIL GRIGUTIS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S JACKSON ST 2ND FLOOR
LOUISVILLE KY
40202-1622
US

IV. Provider business mailing address

501 E BROADWAY STE 290
LOUISVILLE KY
40202-1785
US

V. Phone/Fax

Practice location:
  • Phone: 502-562-6511
  • Fax: 502-562-6512
Mailing address:
  • Phone: 502-217-8221
  • Fax: 502-217-5056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3333P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: