Provider Demographics
NPI:1639227275
Name:GREDITOR, ANNA (NP)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:
Last Name:GREDITOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12507 N EMILY LN
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-2611
Mailing Address - Country:US
Mailing Address - Phone:414-915-6255
Mailing Address - Fax:262-243-9676
Practice Address - Street 1:12507 N EMILY LN
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-2611
Practice Address - Country:US
Practice Address - Phone:414-915-6255
Practice Address - Fax:262-243-9676
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2311363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily