MEDICARE: MRS. VIRGINIA ARENT GRECO APNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	2192-033	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558352237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VIRGINIA ARENT GRECO APNP

Provider Business Mailing Address
First Line	:	830 N 109TH ST
Second Line	:	STE 1
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-3754
Country	:	US
Telephone Number	:	414-777-1811
Fax Number	:	414-777-1812

Provider Business Practice Location Address
First Line	:	830 N 109TH ST
Second Line	:	STE 1
City	:	WAUWATOSA
State	:	WI
Zip	:	53226-3754
Country	:	US
Telephone Number	:	414-777-1811
Fax Number	:	414-777-1812

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	12/07/2012

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