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General NPI Number Information
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NPI Number | 1245744960
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Entity Type | Individual
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Provider Name | GRETA BAKANOWSKI APRN
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Gender | Female
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Dates
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Enumeration Date | 11/17/2017
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 8200 MEADOWBRIDGE RD STE 100
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-2337
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Country | US
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Telephone | 804-559-7467
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Fax |
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Provider Business Mailing Address
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Address Line | 1115 BOULDERS PKWY STE 200
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23225-4067
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Country | US
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Telephone | 804-915-4607
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71007767A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3011745
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0024178628
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License Number State | VA
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