Provider Demographics
NPI:1972693794
Name:ABRUZZESE, GRETA R (RN, CNP)
Entity Type:Individual
Prefix:MS
First Name:GRETA
Middle Name:R
Last Name:ABRUZZESE
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 METRO BLVD STE 255
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2355
Mailing Address - Country:US
Mailing Address - Phone:952-224-4413
Mailing Address - Fax:952-224-4415
Practice Address - Street 1:7400 METRO BLVD STE 255
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2355
Practice Address - Country:US
Practice Address - Phone:952-224-4413
Practice Address - Fax:952-224-4415
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP3397363LF0000X
MNR080266-4163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN385380200Medicaid