Provider Demographics
NPI:1962267187
Name:GREY, EMMA KATHERINE (CRNP)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:KATHERINE
Last Name:GREY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803A ADDISON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1302
Mailing Address - Country:US
Mailing Address - Phone:302-419-6622
Mailing Address - Fax:
Practice Address - Street 1:1101 CHESTNUT ST FL 11
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-3619
Practice Address - Country:US
Practice Address - Phone:215-955-4888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASPO28722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily