Provider Demographics
NPI:1386287175
Name:CRISCO, GRETA H (NP)
Entity type:Individual
Prefix:
First Name:GRETA
Middle Name:H
Last Name:CRISCO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 632
Mailing Address - Street 2:
Mailing Address - City:STANFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:28163-0632
Mailing Address - Country:US
Mailing Address - Phone:704-984-1817
Mailing Address - Fax:612-688-6267
Practice Address - Street 1:101 CABARRUS AVE E
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-3699
Practice Address - Country:US
Practice Address - Phone:855-743-2247
Practice Address - Fax:612-688-6267
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF09191855207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine