Provider Demographics
NPI:1730985128
Name:GRILL, MIA ELIZABETH (NP)
Entity type:Individual
Prefix:MRS
First Name:MIA
Middle Name:ELIZABETH
Last Name:GRILL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:
Other - Last Name:BYHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11010 BLUEBIRD DR
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-2496
Mailing Address - Country:US
Mailing Address - Phone:814-795-4489
Mailing Address - Fax:
Practice Address - Street 1:11010 BLUEBIRD DR
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-2496
Practice Address - Country:US
Practice Address - Phone:814-795-4489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP032211363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner