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General NPI Number Information
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NPI Number | 1164527164
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Entity Type | Individual
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Provider Name | JENNIFER ANNE GRELLA APRN,BC
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Gender | Female
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 363 ROUTE 111 SUITE 101
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City | SMITHTOWN
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State | NY
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Zip | 11787-4756
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Country | US
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Telephone | 631-724-8075
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Fax | 631-724-8076
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Provider Business Mailing Address
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Address Line | 25 ASTER AVE
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City | HOLTSVILLE
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State | NY
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Zip | 11742-1733
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Country | US
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Telephone | 631-207-2262
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Fax | 631-207-2262
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F303036-1
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License Number State | NY
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