Provider Demographics
NPI:1457953762
Name:THORKELSON, GRETA
Entity type:Individual
Prefix:
First Name:GRETA
Middle Name:
Last Name:THORKELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5725 FORWARD AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-2255
Mailing Address - Country:US
Mailing Address - Phone:412-214-0042
Mailing Address - Fax:412-385-2468
Practice Address - Street 1:5725 FORWARD AVE STE 401
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-2255
Practice Address - Country:US
Practice Address - Phone:412-214-0042
Practice Address - Fax:412-385-2468
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN110364952084B0040X
IL209021051363LF0000X
PASP0267612084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily