Healthcare Provider Details

I. General information

NPI: 1598316044
Provider Name (Legal Business Name): DIANE GREENLEAF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHA WINDSOR CLINIC 119 WINDSOR ST
CAMBRIDGE MA
02139
US

IV. Provider business mailing address

329 ASH ST
READING MA
01867-3629
US

V. Phone/Fax

Practice location:
  • Phone: 617-665-3800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number132500
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: