Provider Demographics
NPI:1629074455
Name:GRECO, MAGDALENE (CRNP)
Entity Type:Individual
Prefix:
First Name:MAGDALENE
Middle Name:
Last Name:GRECO
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 1:2827 W CHELTENHAM AVE
Mailing Address - Street 2:
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-2932
Mailing Address - Country:US
Mailing Address - Phone:215-884-8815
Mailing Address - Fax:215-884-5550
Practice Address - Street 1:2827 W CHELTENHAM AVE
Practice Address - Street 2:
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095-2932
Practice Address - Country:US
Practice Address - Phone:215-884-8815
Practice Address - Fax:215-884-5550
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP005191C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS76413Medicare UPIN
PA025473Medicare ID - Type Unspecified