Healthcare Provider Details

I. General information

NPI: 1164451787
Provider Name (Legal Business Name): EILEEN S MORAN GRIGGS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EILEEN S MORAN NP

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 BANDANA BLVD E SUITE 200
SAINT PAUL MN
55108-5113
US

IV. Provider business mailing address

1021 BANDANA BLVD E SUITE 200
SAINT PAUL MN
55108-5113
US

V. Phone/Fax

Practice location:
  • Phone: 651-637-2960
  • Fax: 651-637-2961
Mailing address:
  • Phone: 651-642-2700
  • Fax: 651-642-9441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR1276354
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: