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NPI Code Detail

MEDICARE: CAROL V GREENE NNP

MEDICARE: CAROL V GREENE NNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LN0000XNeonatal Nurse Practitioner247536CA

General Provider Information

NPI Number : 1063419653
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROL V GREENE NNP
Provider Business Mailing Address
First Line : 19441 ROMAR ST
Second Line :
City : NORTHRIDGE
State : CA
Zip : 91324-1139
Country : US
Telephone Number : 818-419-2329
Fax Number : 818-886-2955
Provider Business Practice Location Address
First Line : 18321 CLARK ST
Second Line :
City : TARZANA
State : CA
Zip : 91356-3501
Country : US
Telephone Number : 818-708-5242
Fax Number : 818-508-5266
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2005
Last Update Date : 07/08/2007

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