Provider Demographics
NPI:1962499830
Name:GREISSINGER, GEORGANN MARIE (FNP CNM)
Entity Type:Individual
Prefix:
First Name:GEORGANN
Middle Name:MARIE
Last Name:GREISSINGER
Suffix:
Gender:F
Credentials:FNP CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 S. NATIONAL AVE
Mailing Address - Street 2:STE. 540
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5284
Mailing Address - Country:US
Mailing Address - Phone:417-236-2680
Mailing Address - Fax:417-236-2683
Practice Address - Street 1:25376 STATE HWY 39
Practice Address - Street 2:#301
Practice Address - City:SHELL KNOB
Practice Address - State:MO
Practice Address - Zip Code:65747-7343
Practice Address - Country:US
Practice Address - Phone:417-236-2680
Practice Address - Fax:417-236-2683
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK 07944-104-02363LF0000X
AK07944-104-02367A00000X
MO2008004559363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP3686Medicaid
MO146350001Medicare Oscar/Certification
AK160828Medicare ID - Type Unspecified
AKNP3686Medicaid
AKP71951Medicare ID - Type UnspecifiedINDIVIDUAL #