Provider Demographics
NPI:1245428366
Name:GREVEN, DAMON E (NP-C)
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:E
Last Name:GREVEN
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:672 COUNTY ROAD 64
Mailing Address - Street 2:
Mailing Address - City:GARRETT
Mailing Address - State:IN
Mailing Address - Zip Code:46738-9754
Mailing Address - Country:US
Mailing Address - Phone:260-466-7349
Mailing Address - Fax:
Practice Address - Street 1:672 COUNTY ROAD 64
Practice Address - Street 2:
Practice Address - City:GARRETT
Practice Address - State:IN
Practice Address - Zip Code:46738-9754
Practice Address - Country:US
Practice Address - Phone:260-466-7349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002515A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0748972Medicaid
IN000000566036OtherANTHEM
IN200879230Medicaid
IN100081380Medicaid
OH2788354Medicaid
INP00664349OtherMEDICARE RAILROAD
OH2788354Medicaid
IN136140Medicare PIN
IN000000566036OtherANTHEM
OH9928923Medicare PIN