Basic Information
Provider Information
NPI: 1417074204
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GRILLEY-OLSON
FirstName: JUNEKO
MiddleName: ELAINE
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: UNC CHAPEL HILL DIVISION OF HEMATOLOGY ONCOLOGY
Address2: CB 7305, 3009 OLD CLINIC BLDG
City: CHAPEL HILL
State: NC
PostalCode: 275997305
CountryCode: US
TelephoneNumber: 9199664970
FaxNumber:  
Practice Location
Address1: UNC CHAPEL HILL DIVISION OF HEMATOLOGY ONCOLOGY
Address2: CB 7305, 3009 OLD CLINIC BLDG
City: CHAPEL HILL
State: NC
PostalCode: 275997305
CountryCode: US
TelephoneNumber: 9199664970
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/25/2007
LastUpdateDate: 09/14/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0003XAN3208065960146NCY Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

No ID Information.


Home