MEDICARE: MICHAEL W GREENLEE MSRN, FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F334395	NY

General Provider Information

NPI Number	:	1285629170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL W GREENLEE MSRN, FNP

Provider Business Mailing Address
First Line	:	28 B EBP
Second Line	:	200 RIDGE ROAD WEST
City	:	ROCHESTER
State	:	NY
Zip	:	14652-3402
Country	:	US
Telephone Number	:	585-722-9126
Fax Number	:	585-477-9276

Provider Business Practice Location Address
First Line	:	28 B EBP
Second Line	:	200 RIDGE ROAD WEST
City	:	ROCHESTER
State	:	NY
Zip	:	14652-3402
Country	:	US
Telephone Number	:	585-722-9126
Fax Number	:	585-477-9276

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	10/18/2022

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