Provider Demographics
NPI:1033391784
Name:GREAVES, JESSICA ANN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:GREAVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 RENNISON RD
Mailing Address - Street 2:
Mailing Address - City:GRAHAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12740-5214
Mailing Address - Country:US
Mailing Address - Phone:845-985-7874
Mailing Address - Fax:
Practice Address - Street 1:16 CHARLES STREET
Practice Address - Street 2:
Practice Address - City:ELLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12428-2334
Practice Address - Country:US
Practice Address - Phone:845-647-4502
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
NY590085163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse