Provider Demographics
NPI:1376581736
Name:GREKSA, ANNELIESE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:ANNELIESE
Middle Name:
Last Name:GREKSA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 DEFENSE HWY
Mailing Address - Street 2:SUITE 403
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7027
Mailing Address - Country:US
Mailing Address - Phone:410-571-2946
Mailing Address - Fax:410-571-2947
Practice Address - Street 1:116 DEFENSE HWY
Practice Address - Street 2:SUITE 403
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7027
Practice Address - Country:US
Practice Address - Phone:410-571-2946
Practice Address - Fax:410-571-2947
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR110318363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP51042Medicare UPIN