Provider Demographics
NPI:1528729563
Name:GREHN, NICOLE (AGPCNP-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:GREHN
Suffix:
Gender:F
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 GRAND ST APT 5B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-4103
Mailing Address - Country:US
Mailing Address - Phone:414-313-8350
Mailing Address - Fax:
Practice Address - Street 1:234 ORINOCO DR
Practice Address - Street 2:
Practice Address - City:BRIGHTWATERS
Practice Address - State:NY
Practice Address - Zip Code:11718-1822
Practice Address - Country:US
Practice Address - Phone:631-300-0797
Practice Address - Fax:631-647-8429
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY801426163W00000X
NYF310519363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse