Individual
MRS. JESSICA GRIGOREVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
112 W ROSS BLVD, DODGE CITY, KS 67801-7219
(620) 371-7130
Mailing address
112 W ROSS BLVD, DODGE CITY, KS 67801-7219
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
53-75850-031
KS
363LP2300X
Primary Care Nurse Practitioner
78580
KS
Other
Enumeration date
09/22/2017
Last updated
04/08/2019
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