Basic Information
| Provider Information | |||||||||
| NPI: | 1386287175 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRISCO | ||||||||
| FirstName: | GRETA | ||||||||
| MiddleName: | H. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 632 | ||||||||
| Address2: | |||||||||
| City: | STANFIELD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281630632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049841817 | ||||||||
| FaxNumber: | 6126886267 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 CABARRUS AVE E | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280253699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8557432247 | ||||||||
| FaxNumber: | 6126886267 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2019 | ||||||||
| LastUpdateDate: | 11/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | F09191855 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.