Provider Demographics
NPI:1992029151
Name:GREIG, DIANE MARIE (RN, MJN)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MARIE
Last Name:GREIG
Suffix:
Gender:F
Credentials:RN, MJN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 W BURNSVILLE PKWY
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4237
Mailing Address - Country:US
Mailing Address - Phone:952-564-3030
Mailing Address - Fax:952-564-3038
Practice Address - Street 1:2105 W BURNSVILLE PKWY
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4237
Practice Address - Country:US
Practice Address - Phone:952-564-3030
Practice Address - Fax:952-564-3038
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR106957-4163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNR106957-0OtherMINNESOTA BOARD OF NURSING