Gage Grispino

Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Maryville, MO

NPI 1649866005 · NPPES record last updated Dec 18, 2020

Key facts

NPI
1649866005
Entity type
Individual (NPI type 1)
Primary specialty
Student in an Organized Health Care Education/Training Program 390200000X
Practice address
24694 Hawk Rd
Maryville, MO 64468-8185
Phone
(660) 254-4459
NPI assigned
Dec 18, 2020
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Yes

Addresses

Primary practice location

24694 Hawk Rd
Maryville, MO 64468-8185

Mailing address

24694 Hawk Rd
Maryville, MO 64468-8185
Phone (660) 254-4459

Other providers in Maryville, MO

All providers in Maryville, MO · Student in an Organized Health Care Education/Training Program in Missouri

Sources for this page

Verify at the official NPI Registry.