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General NPI Number Information
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NPI Number | 1982264487
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Entity Type | Individual
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Provider Name | MELVIN EARL GRISBY JR.
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Gender | Male
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Dates
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Enumeration Date | 06/17/2019
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Last Update Date | 06/17/2019
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Provider Practice Location Address
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Address Line | N92W17420 APPLETON AVE STE 102
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-1363
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Country | US
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Telephone | 262-732-7008
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Fax | 262-735-7549
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Provider Business Mailing Address
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Address Line | N92W17420 APPLETON AVE STE 102
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-1363
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Country | US
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Telephone | 262-732-7008
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Fax | 262-735-7549
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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