Individual
MR. NICHOLAS JON GRIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
3113 N DOUSMAN ST, MILWAUKEE, WI 53212-2245
(414) 640-7656
(414) 374-5364
Mailing address
3113 N DOUSMAN ST, MILWAUKEE, WI 53212-2245
(414) 640-7656
(414) 374-5364
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
313012-31
WI
Other
Enumeration date
12/04/2010
Last updated
12/04/2010
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