Provider Demographics
NPI:1306099874
Name:GREIF, MADELYNE JANE (LNM)
Entity type:Individual
Prefix:MRS
First Name:MADELYNE
Middle Name:JANE
Last Name:GREIF
Suffix:
Gender:F
Credentials:LNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 MOHEGAN AVE
Mailing Address - Street 2:CONNECTICUT COLLEGE STUDENT HEALTH SERVICE
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4125
Mailing Address - Country:US
Mailing Address - Phone:860-439-2288
Mailing Address - Fax:
Practice Address - Street 1:270 MOHEGAN AVE
Practice Address - Street 2:CONNECTICUT COLLEGE STUDENT HEALTH SERVICE
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4125
Practice Address - Country:US
Practice Address - Phone:860-439-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000135367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife