Provider Demographics
NPI:1154655751
Name:GRECO, DEEDEE S (APRN)
Entity Type:Individual
Prefix:MRS
First Name:DEEDEE
Middle Name:S
Last Name:GRECO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 ECHO DR
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-5912
Mailing Address - Country:US
Mailing Address - Phone:860-205-1650
Mailing Address - Fax:
Practice Address - Street 1:120 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1944
Practice Address - Country:US
Practice Address - Phone:860-205-1650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4148363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT06-1406459OtherGREAT WEST HEALTHCARE
CT06-1406459OtherCORVEL
CT06-1406459OtherNORTHEAST HEALTH DIRECT
CT06-1406459OtherWELLCARE
CT06-1406459OtherTRICARE
CT06-1406459OtherCOMMUNITY HEALTH NETWORK
CT06-1406459OtherMULTIPLAN
CT06-1406459OtherPIONEER
CT06-1406459OtherPRIVATE HEALTHCARE SYSTEMS
CT06-1406459OtherAETNA BETTER HEALTH
CT1154655751OtherANTHEM BCBS
CT06-1406459OtherAMERICHOICE UNITED HEALTHCARE