Provider Demographics
NPI:1023780384
Name:GRISET, ELISE (CPO)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:GRISET
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 UNION BLVD STE 440
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1812
Mailing Address - Country:US
Mailing Address - Phone:720-417-8698
Mailing Address - Fax:
Practice Address - Street 1:200 UNION BLVD STE 440
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1812
Practice Address - Country:US
Practice Address - Phone:720-417-8698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CPO04294224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CPO04294OtherCPO CERTIFICATION