Provider Demographics
NPI:1285150797
Name:GRIEGO, STEPHANIE JO (FNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JO
Last Name:GRIEGO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 S SHERIDAN BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80227-5541
Mailing Address - Country:US
Mailing Address - Phone:303-742-3179
Mailing Address - Fax:
Practice Address - Street 1:3100 S SHERIDAN BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80227-5541
Practice Address - Country:US
Practice Address - Phone:303-742-3179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1617869163W00000X
CO0993305363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0993305OtherFAMILY NURSE PRACTITIONER
CO1617869OtherREGISTERED NURSE