Healthcare Provider Details

I. General information

NPI: 1457953762
Provider Name (Legal Business Name): GRETA THORKELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5725 FORWARD AVE STE 401
PITTSBURGH PA
15217-2255
US

IV. Provider business mailing address

5725 FORWARD AVE STE 401
PITTSBURGH PA
15217-2255
US

V. Phone/Fax

Practice location:
  • Phone: 412-214-0042
  • Fax: 412-385-2468
Mailing address:
  • Phone: 412-214-0042
  • Fax: 412-385-2468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberAPRN11036495
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209021051
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberSP026761
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: