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NPI Code Detail

MEDICARE: DR. RANDEE GREENWALD NP

MEDICARE: DR. RANDEE GREENWALD NP
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
1163W00000XRegistered NurseR34514NM
2363LF0000XFamily Nurse PractitionerCNP00716NM

General Provider Information

NPI Number : 1740395268
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RANDEE GREENWALD NP
Provider Business Mailing Address
First Line : PO BOX 2736
Second Line :
City : LAS CRUCES
State : NM
Zip : 88004-2736
Country : US
Telephone Number : 575-649-6122
Fax Number :
Provider Business Practice Location Address
First Line : 300 N CAMPO ST
Second Line :
City : LAS CRUCES
State : NM
Zip : 88001-3433
Country : US
Telephone Number : 575-524-1230
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2006
Last Update Date : 07/12/2019

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