Provider Demographics
NPI:1689751786
Name:GREICUS, LAURA A (RN, RNP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:A
Last Name:GREICUS
Suffix:
Gender:F
Credentials:RN, RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2663 39TH AVE
Mailing Address - Street 2:#3
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-2754
Mailing Address - Country:US
Mailing Address - Phone:415-571-8319
Mailing Address - Fax:415-571-8319
Practice Address - Street 1:2130 FILLMORE ST
Practice Address - Street 2:#397
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2224
Practice Address - Country:US
Practice Address - Phone:415-373-7446
Practice Address - Fax:415-571-8319
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11017363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP 11017OtherNP CERTIFICATE
CARN 488022OtherRN LICENCE
CANP 11017OtherNP CERTIFICATE