Provider Demographics
NPI:1730659475
Name:GREER, NEDDA KAY (LAC)
Entity Type:Individual
Prefix:
First Name:NEDDA
Middle Name:KAY
Last Name:GREER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:NEDDA
Other - Middle Name:KAY
Other - Last Name:JASTREMSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:CENTRACARE CLINIC
Mailing Address - Street 2:2001 STOCKINGER DR, STE 101
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1243
Mailing Address - Country:US
Mailing Address - Phone:320-534-3096
Mailing Address - Fax:
Practice Address - Street 1:CENTRACARE CLINIC
Practice Address - Street 2:2001 STOCKINGER DR, STE 101
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1243
Practice Address - Country:US
Practice Address - Phone:320-534-3096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1869171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist