Individual
LIESEL C GRENTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
124 DOWELL RD, RUSSELL SPRINGS, KY 42642-4278
(270) 866-2440
(270) 866-2442
Mailing address
124 DOWELL RD, RUSSELL SPRINGS, KY 42642-4278
(270) 866-2440
(270) 866-2442
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
03238
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100046590
—
KY
Enumeration date
02/08/2008
Last updated
05/24/2019
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