Provider Demographics
NPI:1477688257
Name:GULEZIAN, GREETA ZORN (ANP)
Entity Type:Individual
Prefix:
First Name:GREETA
Middle Name:ZORN
Last Name:GULEZIAN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7411 LAKE ST
Mailing Address - Street 2:SUITE L140
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1888
Mailing Address - Country:US
Mailing Address - Phone:708-763-5540
Mailing Address - Fax:708-383-2324
Practice Address - Street 1:WOMEN'S HEALTH CENTER
Practice Address - Street 2:7339 W. MADISON AVE
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-1543
Practice Address - Country:US
Practice Address - Phone:708-386-2400
Practice Address - Fax:708-366-7035
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILNONEOtherIN THE PROCESS OF CREDENT