Provider Demographics
NPI:1962103127
Name:TIGNOR-GRILE, ANDREW LYNN (MINISTRY)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:LYNN
Last Name:TIGNOR-GRILE
Suffix:
Gender:M
Credentials:MINISTRY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18065 SE LAMPER CT
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-8301
Mailing Address - Country:US
Mailing Address - Phone:971-264-0314
Mailing Address - Fax:
Practice Address - Street 1:777 STANTON BLVD # 10612992
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-8335
Practice Address - Country:US
Practice Address - Phone:971-264-0314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHONORARY374K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner