Provider Demographics
NPI:1376008276
Name:MANN, GRETA MILLS (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:GRETA
Middle Name:MILLS
Last Name:MANN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MRS
Other - First Name:GRETA
Other - Middle Name:MILLS
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:5253 PRUE RD STE 315C
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1758
Mailing Address - Country:US
Mailing Address - Phone:210-750-8100
Mailing Address - Fax:210-750-8101
Practice Address - Street 1:5253 PRUE RD STE 315C
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1758
Practice Address - Country:US
Practice Address - Phone:210-750-8100
Practice Address - Fax:210-750-8101
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84933363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology