1265469043 NPI number — DR. KAREN ELAINE GRECO PHD, RN, ANP

Table of content: DR. KAREN ELAINE GRECO PHD, RN, ANP (NPI 1265469043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265469043 NPI number — DR. KAREN ELAINE GRECO PHD, RN, ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRECO
Provider First Name:
KAREN
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, RN, ANP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265469043
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1360 SW TURNER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST LINN
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97068-9662
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-638-0500
Provider Business Mailing Address Fax Number:
503-638-0650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 MOLALLA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OREGON CITY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97045-2652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-722-4400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  000031382N3 ANP-PP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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