Provider Demographics
NPI:1063949063
Name:GRIZZELL, KRISTIN LUNDEEN (DAC)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:LUNDEEN
Last Name:GRIZZELL
Suffix:
Gender:F
Credentials:DAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 DICKEY DR
Mailing Address - Street 2:
Mailing Address - City:DAVIDSONVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21035-1131
Mailing Address - Country:US
Mailing Address - Phone:443-584-3047
Mailing Address - Fax:
Practice Address - Street 1:2101 DEFENSE HWY STE A
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2401
Practice Address - Country:US
Practice Address - Phone:443-584-3047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02129171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist