Provider Demographics
NPI:1790260628
Name:PALKO-GRIEGGS, LEANNE MARIE (CRNP)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:MARIE
Last Name:PALKO-GRIEGGS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LEANNE
Other - Middle Name:MARIE
Other - Last Name:PALKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:4815 LIBERTY AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2156
Mailing Address - Country:US
Mailing Address - Phone:412-578-6808
Mailing Address - Fax:412-688-7517
Practice Address - Street 1:4815 LIBERTY AVE STE 160
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-578-6808
Practice Address - Fax:412-688-7517
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019326363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103588380Medicaid
14390844OtherCAQH