Provider Demographics
NPI:1730289638
Name:CLARKE, GRETA FAY
Entity Type:Individual
Prefix:
First Name:GRETA
Middle Name:FAY
Last Name:CLARKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GRETA
Other - Middle Name:FAY
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:110 LITTONDALE CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-1381
Mailing Address - Country:US
Mailing Address - Phone:302-374-8233
Mailing Address - Fax:
Practice Address - Street 1:1601 KIRKWOOD HWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-4917
Practice Address - Country:US
Practice Address - Phone:302-633-5454
Practice Address - Fax:302-633-5590
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELD0000103363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health