Provider Demographics
NPI:1578859518
Name:GREIS, LYDIA MARIE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:MARIE
Last Name:GREIS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MS
Other - First Name:LYDIA
Other - Middle Name:MARIE
Other - Last Name:KOERITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:2001 BLAISDELL AVE S
Mailing Address - Street 2:PARK NICOLLET CLINIC
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404
Mailing Address - Country:US
Mailing Address - Phone:952-993-8000
Mailing Address - Fax:952-993-8039
Practice Address - Street 1:2001 BLAISDELL AVE S
Practice Address - Street 2:PARK NICOLLET CLINIC
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404
Practice Address - Country:US
Practice Address - Phone:952-993-8000
Practice Address - Fax:952-993-8039
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR179494-8163W00000X
MNG0611003363LG0600X
MNR179498-8363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology