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General NPI Number Information
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NPI Number | 1235210642
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Entity Type | Individual
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Provider Name | LUCILLE ANN GRIETSELL CNNP
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Gender | Female
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 2799 W GRAND BLVD
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City | DETROIT
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State | MI
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Zip | 48202-2608
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Country | US
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Telephone | 313-916-0466
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Fax |
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Provider Business Mailing Address
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Address Line | 14127 MIDDLE GIBRALTAR RD
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City | ROCKWOOD
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State | MI
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Zip | 48173-9772
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Country | US
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Telephone | 734-676-3217
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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 | 363LN0005X
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Taxonomy Name | Critical Care Neonatal Nurse Practitioner
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License Number | 4704134681
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License Number State | MI
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