Individual
LAURENCE GRISANTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
522 SW 5TH AVE, SUITE 1125, PORTLAND, OR 97204-2133
(503) 395-8326
Mailing address
1020 SW TAYLOR ST, SUITE 700, PORTLAND, OR 97205-2512
(503) 395-8326
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
201050181NP
OR
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
200640886 RN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123190
—
OR
Enumeration date
10/08/2009
Last updated
10/28/2016
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