MEDICARE: MS. NANCY DARLENE GRILLOT 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	NP06913	OH

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	:	1659400331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY DARLENE GRILLOT NP

Provider Business Mailing Address
First Line	:	5454 BLUESKY DR
Second Line	:	UNIT 15
City	:	CINCINNATI
State	:	OH
Zip	:	45247-6437
Country	:	US
Telephone Number	:	513-490-4822
Fax Number	:

Provider Business Practice Location Address
First Line	:	5970 KENWOOD RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45243-2930
Country	:	US
Telephone Number	:	513-561-4111
Fax Number	:

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	06/07/2009

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