Provider Demographics
NPI:1386651925
Name:O'STEEN, GRETA D (RN)
Entity Type:Individual
Prefix:
First Name:GRETA
Middle Name:D
Last Name:O'STEEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-3525
Mailing Address - Country:US
Mailing Address - Phone:912-338-5916
Mailing Address - Fax:912-287-6521
Practice Address - Street 1:1101 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-3525
Practice Address - Country:US
Practice Address - Phone:912-338-5916
Practice Address - Fax:912-287-6521
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN093078163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000852332DMedicaid