Provider Demographics
NPI:1386234037
Name:GRIESBACH, STEPHANIE HOFF (CPNP-PC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:HOFF
Last Name:GRIESBACH
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:HOFF
Other - Last Name:PEDERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP-PC
Mailing Address - Street 1:P.O. BOX 804435
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-4435
Mailing Address - Country:US
Mailing Address - Phone:816-701-5100
Mailing Address - Fax:816-302-9939
Practice Address - Street 1:2401 GILLHAM RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-4619
Practice Address - Country:US
Practice Address - Phone:816-701-5100
Practice Address - Fax:816-302-9939
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-79907-022208000000X, 363LP0200X
MO2021004837208000000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS53-79907-022Medicaid
MO2021004837Medicaid