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General NPI Number Information
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NPI Number | 1548025034
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Entity Type | Individual
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Provider Name | CHRISTINA MARIE GREESE APRN
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Gender | Female
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Dates
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Enumeration Date | 02/14/2024
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 80 PHOENIX AVE
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City | WATERBURY
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State | CT
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Zip | 06702-1418
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Country | US
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Telephone | 203-756-8021
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Fax |
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Provider Business Mailing Address
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Address Line | 47 DEWEY AVE
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City | BRISTOL
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State | CT
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Zip | 06010-7306
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Country | US
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Telephone | 631-241-1679
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F311309-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 12672
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License Number State | CT
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