Healthcare Provider Details

I. General information

NPI: 1679861785
Provider Name (Legal Business Name): CHELSEA NICOLE GRIGERY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 DOCTORS PARK
CAPE GIRARDEAU MO
63703-4927
US

IV. Provider business mailing address

164 TALBOT DR
CAPE GIRARDEAU MO
63701-8871
US

V. Phone/Fax

Practice location:
  • Phone: 573-331-6750
  • Fax:
Mailing address:
  • Phone: 816-812-8513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20110118539
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: