Provider Demographics
NPI:1942722574
Name:GREFFET, LYDIA N (PA-C)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:N
Last Name:GREFFET
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:N
Other - Last Name:REINHOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:314-843-7557
Mailing Address - Fax:314-849-8671
Practice Address - Street 1:4460 S LINDBERGH BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1647
Practice Address - Country:US
Practice Address - Phone:314-843-7557
Practice Address - Fax:417-269-2270
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2017028633OtherPA STATE LICENSE