Healthcare Provider Details

I. General information

NPI: 1003338948
Provider Name (Legal Business Name): KATHLEEN GRIEGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 ST. MICHAELS DRIVE SUITE #3
SANTA FE NM
87505
US

IV. Provider business mailing address

411 SAINT MICHAELS DR STE 3
SANTA FE NM
87505-7655
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-9035
  • Fax:
Mailing address:
  • Phone: 505-913-9035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: