Provider Demographics
NPI:1871586040
Name:GRENICH, LORI JEAN (MS, MSN, RN, CNP)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:JEAN
Last Name:GRENICH
Suffix:
Gender:F
Credentials:MS, MSN, RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9471 MARKET ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTH LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:44452-8702
Mailing Address - Country:US
Mailing Address - Phone:330-729-2388
Mailing Address - Fax:330-629-6468
Practice Address - Street 1:107 ROYAL BIRKDALE DR STE A
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:OH
Practice Address - Zip Code:44408
Practice Address - Country:US
Practice Address - Phone:330-482-9350
Practice Address - Fax:339-472-2336
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH03474NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2374121Medicaid
P24459Medicare UPIN
OH2374121Medicaid