Healthcare Provider Details

I. General information

NPI: 1336425099
Provider Name (Legal Business Name): CHRISTINE ELIZABETH GRISSETT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 HOSPITAL DR NE
BOLIVIA NC
28422-8346
US

IV. Provider business mailing address

240 HOSPITAL DR NE
BOLIVIA NC
28422-8346
US

V. Phone/Fax

Practice location:
  • Phone: 910-755-1004
  • Fax: 910-755-1474
Mailing address:
  • Phone: 910-755-8121
  • Fax: 910-721-1359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number175136
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: