Provider Demographics
NPI:1427008655
Name:GRIGGS, DENNIS L (CRNA)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:L
Last Name:GRIGGS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34510
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-4510
Mailing Address - Country:US
Mailing Address - Phone:702-560-2915
Mailing Address - Fax:702-560-2928
Practice Address - Street 1:2450 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2179
Practice Address - Country:US
Practice Address - Phone:702-877-8661
Practice Address - Fax:702-258-1322
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28065047RN367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000201484OtherBLUE SHIELD
IN100001050Medicaid
430004555OtherRAILROAD MEDICARE
IN100001050Medicaid
INCC2080BMedicare PIN