Healthcare Provider Details

I. General information

NPI: 1114901659
Provider Name (Legal Business Name): JAMES GREENLEE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3841 BRICKWAY BLVD HBPC, VA SAN FRANCISCO HEALTH CARE SYSTEM
SANTA ROSA CA
95403-8226
US

IV. Provider business mailing address

824 VINEYARD CREEK DR #276
SANTA ROSA CA
95403-9006
US

V. Phone/Fax

Practice location:
  • Phone: 707-569-2369
  • Fax: 707-569-2323
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number9846
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: