Provider Demographics
NPI:1336697234
Name:GRECO, LAURA (FNP, PMHNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GRECO
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 S CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4631
Mailing Address - Country:US
Mailing Address - Phone:708-819-7720
Mailing Address - Fax:
Practice Address - Street 1:1909 OGDEN AVE STE A
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2602
Practice Address - Country:US
Practice Address - Phone:630-750-7920
Practice Address - Fax:888-309-5146
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012390363LP0808X
IL209014817363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health