Individual
BRADLEY WAYNE GRISSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
N.P.
Contact information
Practice address
516 W MADISON ST, DANVILLE, IL 61832-5657
(217) 554-1700
(217) 554-1704
Mailing address
P.O. BOX 6002, URBANA, IL 61803-6002
(217) 326-8300
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209005691
IL
Other
Enumeration date
02/21/2007
Last updated
03/12/2025
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