Healthcare Provider Details

I. General information

NPI: 1942722574
Provider Name (Legal Business Name): LYDIA N. GREFFET PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYDIA N. REINHOLD PA-C

II. Dates (important events)

Enumeration Date: 07/14/2017
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4460 S LINDBERGH BLVD
SAINT LOUIS MO
63127-1647
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-6084
US

V. Phone/Fax

Practice location:
  • Phone: 314-843-7557
  • Fax: 417-269-2270
Mailing address:
  • Phone: 314-843-7557
  • Fax: 314-849-8671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: