Provider Demographics
NPI:1992973218
Name:GRISWOLD, MARY MELINDA (APRN)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:MELINDA
Last Name:GRISWOLD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 31ST ST
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:KS
Mailing Address - Zip Code:67490-8740
Mailing Address - Country:US
Mailing Address - Phone:785-761-6865
Mailing Address - Fax:620-792-7052
Practice Address - Street 1:611 31ST ST
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:KS
Practice Address - Zip Code:67490-8740
Practice Address - Country:US
Practice Address - Phone:785-761-6505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-75175-012363LF0000X
KS13-91537-012163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC1400XNursing Service ProvidersRegistered NurseCollege Health