MEDICARE: MRS. LYDIA MAY GREBE APN

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	363LF0000X	Family Nurse Practitioner	26NN09610400	NJ

General Provider Information

NPI Number	:	1780788729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYDIA MAY GREBE APN

Provider Business Mailing Address
First Line	:	401 ROUTE 73 N STE 320
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-3426
Country	:	US
Telephone Number	:	609-298-3304
Fax Number	:

Provider Business Practice Location Address
First Line	:	23659 COLUMBUS RD STE 4
Second Line	:
City	:	COLUMBUS
State	:	NJ
Zip	:	08022-1980
Country	:	US
Telephone Number	:	609-298-3304
Fax Number	:	609-298-7091

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

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	12/19/2022

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