MEDICARE: CAMILLE GRISWOLD MSN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	4704192319	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437139318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLE GRISWOLD MSN NP

Provider Business Mailing Address
First Line	:	1221 SIXTH ST
Second Line	:	SUITE 206
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2701
Country	:	US
Telephone Number	:	231-935-5090
Fax Number	:	231-935-5093

Provider Business Practice Location Address
First Line	:	1221 SIXTH ST
Second Line	:	SUITE 206
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49684-2701
Country	:	US
Telephone Number	:	231-935-5090
Fax Number	:	231-935-5093

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	01/20/2010

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