MEDICARE: LUELLEN ANN GREENLICK 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
1	364SW0102X	Women's Health Clinical Nurse Specialist	000646	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649403841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUELLEN ANN GREENLICK NP

Provider Business Mailing Address
First Line	:	2428 ALLEGRETTO AVE
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-6640
Country	:	US
Telephone Number	:	702-612-1164
Fax Number	:

Provider Business Practice Location Address
First Line	:	8480 S EASTERN AVE STE F
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2822
Country	:	US
Telephone Number	:	702-914-6900
Fax Number	:	702-914-6904

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2009
Last Update Date	:	10/25/2022

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