Healthcare Provider Details

I. General information

NPI: 1972845188
Provider Name (Legal Business Name): DAWN ELIZABETH GRESKO PMH-CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18660 BAGLEY RD STE 404
MIDDLEBURG HEIGHTS OH
44130-3483
US

IV. Provider business mailing address

18660 BAGLEY RD STE 404
MIDDLEBURG HEIGHTS OH
44130-3483
US

V. Phone/Fax

Practice location:
  • Phone: 404-234-8746
  • Fax: 440-234-8746
Mailing address:
  • Phone: 330-690-9311
  • Fax: 216-450-1614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN.CNS.13865
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: