Provider Demographics
NPI:1700136827
Name:GRECO, KELLY K (APRN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:K
Last Name:GRECO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:31 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2304
Mailing Address - Country:US
Mailing Address - Phone:203-234-1324
Mailing Address - Fax:203-239-3047
Practice Address - Street 1:46 PRINCE ST STE 601
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1634
Practice Address - Country:US
Practice Address - Phone:203-752-1726
Practice Address - Fax:203-752-1858
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2016-08-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT004907363L00000X
CT4907363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily