Healthcare Provider Details

I. General information

NPI: 1437637758
Provider Name (Legal Business Name): JUSTEEN A GRIEGO CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 SAN PEDRO DR NE STE C
ALBUQUERQUE NM
87113-1704
US

IV. Provider business mailing address

8300 SAN PEDRO DR NE STE C
ALBUQUERQUE NM
87113-1704
US

V. Phone/Fax

Practice location:
  • Phone: 505-907-5652
  • Fax: 505-212-4021
Mailing address:
  • Phone: 505-907-5652
  • Fax: 505-212-4021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN-72666
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number54134
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number54134
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: