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NPI Code Detail

MEDICARE: JAMES GREENLEE NP

MEDICARE: JAMES GREENLEE NP
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
1363LG0600XGerontology Nurse Practitioner9846CA

General Provider Information

NPI Number : 1114901659
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES GREENLEE NP
Provider Business Mailing Address
First Line : 824 VINEYARD CREEK DR
Second Line : #276
City : SANTA ROSA
State : CA
Zip : 95403-9006
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3841 BRICKWAY BLVD
Second Line : HBPC, VA SAN FRANCISCO HEALTH CARE SYSTEM
City : SANTA ROSA
State : CA
Zip : 95403-8226
Country : US
Telephone Number : 707-569-2369
Fax Number : 707-569-2323
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2005
Last Update Date : 02/02/2010

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