Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | GRE104354697 | MN |
NPI | 1134437353 |
---|---|
Provider Name | Andrea Joy Greseth |
First Address | Minneapolis, MN 55404-4518 |
Second Address | St Louis Park, MN 55426-4702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2010 |
Last Update Date | 17/03/2018 |