Healthcare Provider Details

I. General information

NPI: 1235517244
Provider Name (Legal Business Name): RITA GREENE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RITA NEELEY

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44572 W BOWLIN RD
MARICOPA AZ
85138-4558
US

IV. Provider business mailing address

PO BOX 10097
CASA GRANDE AZ
85130-0020
US

V. Phone/Fax

Practice location:
  • Phone: 520-568-2245
  • Fax: 520-568-2316
Mailing address:
  • Phone: 520-836-3446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP 60502642
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number240170
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: