Healthcare Provider Details

I. General information

NPI: 1740978477
Provider Name (Legal Business Name): MICHELLE GREJTAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 05/01/2023
Certification Date: 04/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 E SWEDESFORD RD STE 1000
WAYNE PA
19087-1896
US

IV. Provider business mailing address

440 E SWEDESFORD RD STE 1000
WAYNE PA
19087-1896
US

V. Phone/Fax

Practice location:
  • Phone: 724-205-4793
  • Fax:
Mailing address:
  • Phone: 724-205-4793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN51958IL
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: