Provider Demographics
NPI:1679222368
Name:GRECCO, CRISTAL
Entity Type:Individual
Prefix:
First Name:CRISTAL
Middle Name:
Last Name:GRECCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 S SENECA ST LOT 2
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67217-4439
Mailing Address - Country:US
Mailing Address - Phone:407-912-8423
Mailing Address - Fax:
Practice Address - Street 1:4320 S SENECA ST LOT 2
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67217-4439
Practice Address - Country:US
Practice Address - Phone:407-912-8423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator