Provider Demographics
NPI:1336327998
Name:GRELLA, VICTORIA M (RN)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:M
Last Name:GRELLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-1934
Mailing Address - Country:US
Mailing Address - Phone:516-671-3129
Mailing Address - Fax:516-572-5612
Practice Address - Street 1:27 ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-1934
Practice Address - Country:US
Practice Address - Phone:516-671-3129
Practice Address - Fax:516-572-5612
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22 318971163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse