Healthcare Provider Details

I. General information

NPI: 1497144786
Provider Name (Legal Business Name): RACHAEL GREENSIDES FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4824 E BASELINE RD 3-125
MESA AZ
85206-4676
US

IV. Provider business mailing address

4824 E BASELINE RD 3-125
MESA AZ
85206-4676
US

V. Phone/Fax

Practice location:
  • Phone: 480-839-4848
  • Fax: 480-833-8310
Mailing address:
  • Phone: 480-839-4848
  • Fax: 480-833-8310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP7550
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: