Provider Demographics
NPI:1013199785
Name:VANDEWATER, GRETA CATHERINE (RN)
Entity Type:Individual
Prefix:MS
First Name:GRETA
Middle Name:CATHERINE
Last Name:VANDEWATER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 ENTRANCE WAY
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-1302
Mailing Address - Country:US
Mailing Address - Phone:845-519-6032
Mailing Address - Fax:
Practice Address - Street 1:40 ENTRANCE WAY
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-1302
Practice Address - Country:US
Practice Address - Phone:845-519-6032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY559430-1163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics