Healthcare Provider Details

I. General information

NPI: 1154853893
Provider Name (Legal Business Name): JENNIFER GRIEBEL APRN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MORE RN

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 AVENUE B STE 1110
SCOTTSBLUFF NE
69361-4617
US

IV. Provider business mailing address

3911 AVENUE B STE 1110
SCOTTSBLUFF NE
69361-4617
US

V. Phone/Fax

Practice location:
  • Phone: 308-630-2100
  • Fax: 308-630-2139
Mailing address:
  • Phone: 308-630-2100
  • Fax: 308-630-2139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number112198
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: