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General NPI Number Information
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NPI Number | 1114687530
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Entity Type | Individual
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Provider Name | CANDY GRISBY RN
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Gender | Female
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Dates
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Enumeration Date | 12/27/2021
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Last Update Date | 12/27/2021
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Provider Practice Location Address
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Address Line | 1717 15TH PL
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City | PLANO
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State | TX
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Zip | 75074-6431
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Country | US
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Telephone | 501-351-7469
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Fax |
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Provider Business Mailing Address
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Address Line | 1391 NW 136TH AVE
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City | SUNRISE
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State | FL
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Zip | 33323-2800
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 841779
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License Number State | TX
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