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General NPI Number Information
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NPI Number | 1306616271
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Entity Type | Individual
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Provider Name | HAILEY ELIZABETH GRITSIUTA
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Gender | Female
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Dates
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Enumeration Date | 01/03/2024
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 2660 GULF FWY S STE 14
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City | LEAGUE CITY
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State | TX
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Zip | 77573-6820
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Country | US
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Telephone | 832-505-3376
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Fax |
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Provider Business Mailing Address
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Address Line | 607 CHESTNUT ST
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City | SOUTH CHARLESTON
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State | WV
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Zip | 25309-1205
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Country | US
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Telephone |
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Fax | 304-766-9139
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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