Basic Information
| Provider Information | |||||||||
| NPI: | 1710274394 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRIEGO | ||||||||
| FirstName: | REGINA | ||||||||
| MiddleName: | JO | ||||||||
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| Credential: | FNP, ACNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 129 KANSAS AVE | ||||||||
| Address2: | |||||||||
| City: | WALSENBURG | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810891818 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 129 KANSAS AVE | ||||||||
| Address2: | |||||||||
| City: | WALSENBURG | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810891818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7197385200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2011 | ||||||||
| LastUpdateDate: | 04/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | NP10270 | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LF0000X | NP10270 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.