Provider Demographics
NPI:1811968514
Name:MCGREW, JOANNE D (FNP)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:D
Last Name:MCGREW
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8971
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80424-9029
Mailing Address - Country:US
Mailing Address - Phone:956-342-1492
Mailing Address - Fax:
Practice Address - Street 1:325 4 O'CLOCK RD
Practice Address - Street 2:D 101
Practice Address - City:BRECKENRIDGE
Practice Address - State:CO
Practice Address - Zip Code:80424
Practice Address - Country:US
Practice Address - Phone:956-342-1492
Practice Address - Fax:505-843-2853
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP109501363LF0000X
CORN-0203395163W00000X
PASP004476B363LF0000X
NMCNP-01618363LF0000X
CONP-0990327363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS42852Medicare UPIN
TXS42852Medicare UPIN