Provider Demographics
NPI:1316459597
Name:GRECO, JACQUELINE MARIE (RN)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:MARIE
Last Name:GRECO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HENDRICK ST
Mailing Address - Street 2:
Mailing Address - City:LAKE GEORGE
Mailing Address - State:NY
Mailing Address - Zip Code:12845-1404
Mailing Address - Country:US
Mailing Address - Phone:518-683-2383
Mailing Address - Fax:
Practice Address - Street 1:18 HUGHES CT
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-2555
Practice Address - Country:US
Practice Address - Phone:518-260-1057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-28
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY713368163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNAMedicaid