Provider Demographics
NPI:1417202656
Name:GREB, JESSICA ANNE (ARNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:GREB
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16515 MERIDIAN E STE 104A
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-6255
Mailing Address - Country:US
Mailing Address - Phone:253-792-6650
Mailing Address - Fax:
Practice Address - Street 1:16515 MERIDIAN E STE 104A
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-6255
Practice Address - Country:US
Practice Address - Phone:253-792-6650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60299877363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily