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General NPI Number Information
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NPI Number | 1710420807
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Entity Type | Individual
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Provider Name | PENNY D GREAVES PMHNP-BC, FNP
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Gender | Female
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Dates
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Enumeration Date | 11/22/2016
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Last Update Date | 01/19/2025
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Provider Practice Location Address
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Address Line | 438 CAMINO DEL RIO S STE 210
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City | SAN DIEGO
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State | CA
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Zip | 92108-3547
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Country | US
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Telephone | 619-255-1652
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Fax | 619-324-7761
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Provider Business Mailing Address
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Address Line | 438 CAMINO DEL RIO S STE 210
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City | SAN DIEGO
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State | CA
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Zip | 92108-3547
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Country | US
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Telephone | 196-255-1652
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Fax | 619-324-7761
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP95005526
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95005526
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN95110928
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License Number State | CA
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