Provider Demographics
NPI:1740557131
Name:GREVE, HEIDI WHEELER (LPN)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:WHEELER
Last Name:GREVE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26979 ELDON DR
Mailing Address - Street 2:
Mailing Address - City:EVANS MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13637-3216
Mailing Address - Country:US
Mailing Address - Phone:315-629-6213
Mailing Address - Fax:
Practice Address - Street 1:224 HARRISON ST
Practice Address - Street 2:SUITE 680
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3056
Practice Address - Country:US
Practice Address - Phone:315-476-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288830164W00000X
AL2-062768164W00000X
OK52407164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse