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General NPI Number Information
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NPI Number | 1851806798
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Entity Type | Individual
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Provider Name | THERESA LOUISE GREENUP
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Gender | Female
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Dates
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Enumeration Date | 12/13/2017
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Last Update Date | 02/12/2020
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Provider Practice Location Address
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Address Line | 1980 DOMINION WAY STE 101
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-1475
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Country | US
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Telephone | 719-358-6428
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Fax |
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Provider Business Mailing Address
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Address Line | 2502 E PIKES PEAK AVE STE 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-6089
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Country | US
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Telephone | 719-314-2327
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Fax |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 993457
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License Number State | CO
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