Individual
JENNIFER S. GRISWOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
1018 SW EMKAY DR, BEND, OR 97702-1010
(541) 716-0113
Mailing address
740 NE 3RD ST STE 3-301, BEND, OR 97701-4700
(541) 716-0113
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
200950013NP
OR
363L00000X
Nurse Practitioner
NP10774
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
202111832NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500604912
—
OR
01
—
NP10774
LICENSE
CA
Enumeration date
08/17/2006
Last updated
01/24/2024
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