Healthcare Provider Details

I. General information

NPI: 1831885672
Provider Name (Legal Business Name): DAVID L GREENE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2023
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 S 4TH ST
LEAVENWORTH KS
66048-5014
US

IV. Provider business mailing address

4101 S 4TH ST
LEAVENWORTH KS
66048-5014
US

V. Phone/Fax

Practice location:
  • Phone: 913-682-2000
  • Fax:
Mailing address:
  • Phone: 913-682-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number89455
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: