Provider Demographics
NPI:1184688343
Name:GRESKO, SUSAN BREAKELL (MSN, CRNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:BREAKELL
Last Name:GRESKO
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-2610
Mailing Address - Country:US
Mailing Address - Phone:215-572-7880
Mailing Address - Fax:215-572-8024
Practice Address - Street 1:1421 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-2610
Practice Address - Country:US
Practice Address - Phone:215-572-7880
Practice Address - Fax:215-572-8024
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP001082D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001461156-0002Medicaid
PA2342494000OtherKEYSTONE HEALTH PLAN EAST
PA30019381OtherKEYSTONE MERCY-ABINGTON
PAGR1666860OtherHIGHMARK BLUE SHIELD
PA1666860OtherPERSONAL/BLUE CHOICE
PA30012908OtherKEYSTONE MERCY-NORRISTOWN