Healthcare Provider Details

I. General information

NPI: 1033294681
Provider Name (Legal Business Name): CAROL S GREENLEE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S 70TH ST STE 200
LINCOLN NE
68510-2452
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-7641
  • Fax: 402-483-0527
Mailing address:
  • Phone: 402-499-6641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number9565380-4402
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: