Healthcare Provider Details

I. General information

NPI: 1891408506
Provider Name (Legal Business Name): GRETA ANNE HENRY MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2022
Last Update Date: 12/28/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14169 43RD AVE N
MINNEAPOLIS MN
55446-3488
US

IV. Provider business mailing address

913 E 26TH ST
MINNEAPOLIS MN
55404-4515
US

V. Phone/Fax

Practice location:
  • Phone: 612-306-7031
  • Fax:
Mailing address:
  • Phone: 612-863-3639
  • Fax: 612-863-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number1563
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: