Healthcare Provider Details

I. General information

NPI: 1396322905
Provider Name (Legal Business Name): DANIELLE NICOLE GRIEB APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2021
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 S TAFT AVE
FREMONT OH
43420-3237
US

IV. Provider business mailing address

295 BLUE HARBOR CT
PERRYSBURG OH
43551-2842
US

V. Phone/Fax

Practice location:
  • Phone: 419-334-6679
  • Fax:
Mailing address:
  • Phone: 419-704-7269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number423577
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: