Healthcare Provider Details

I. General information

NPI: 1629074455
Provider Name (Legal Business Name): MAGDALENE GRECO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2827 W CHELTENHAM AVE
WYNCOTE PA
19095-2932
US

IV. Provider business mailing address

2827 W CHELTENHAM AVE
WYNCOTE PA
19095-2932
US

V. Phone/Fax

Practice location:
  • Phone: 215-884-8815
  • Fax: 215-884-5550
Mailing address:
  • Phone: 215-884-8815
  • Fax: 215-884-5550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP005191C
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: