Healthcare Provider Details

I. General information

NPI: 1962499830
Provider Name (Legal Business Name): GEORGANN MARIE GREISSINGER FNP CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25376 STATE HWY 39 #301
SHELL KNOB MO
65747-7343
US

IV. Provider business mailing address

3800 S. NATIONAL AVE STE. 540
SPRINGFIELD MO
65807-5284
US

V. Phone/Fax

Practice location:
  • Phone: 417-236-2680
  • Fax: 417-236-2683
Mailing address:
  • Phone: 417-236-2680
  • Fax: 417-236-2683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAK 07944-104-02
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number07944-104-02
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2008004559
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: