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Individual

MR. DEAN LEE GRISHAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
650 HUEBNER RD, FORT RILEY, KS 66442-4030
(785) 239-7528
Mailing address
650 HUEBNER RD, FORT RILEY, KS 66442-4030
(785) 239-7528

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001197573
VA
163W00000X
Registered Nurse
14117177012
KS
367500000X
Certified Registered Nurse Anesthetist
0024169253
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
557052
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200743350A
KS
Enumeration date
11/29/2006
Last updated
03/10/2023
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