Healthcare Provider Details

I. General information

NPI: 1659287985
Provider Name (Legal Business Name): MADELINE ELIZABETH GRESCO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 RIDGMONT DR
RIDGWAY PA
15853-9700
US

IV. Provider business mailing address

3544 MEFFERTS RUN RD
WILCOX PA
15870-3326
US

V. Phone/Fax

Practice location:
  • Phone: 814-245-2119
  • Fax:
Mailing address:
  • Phone: 814-335-9428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: