Provider Demographics
NPI:1578379244
Name:GRESLY, CONNIE RENEE (RN)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:RENEE
Last Name:GRESLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4434 W TIERRA BUENA LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-2704
Mailing Address - Country:US
Mailing Address - Phone:602-486-9318
Mailing Address - Fax:
Practice Address - Street 1:4434 W TIERRA BUENA LN
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-2704
Practice Address - Country:US
Practice Address - Phone:602-486-9318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ259593163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency