Doctor Name: | GWENDOLYN TERESE GREENE |
NPI Number: | 1609233329 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | MI0633 |
Business Practice Address: | 1649 West Horizon Ridge Parkway Suite 130 Henderson, NV - 890525080 |
Business Phone Number: | 7029305958 |
Business Fax Number: | 7027969490 |
Mailing Address: | Po Box 620251, LAS VEGAS |
State: | NV |
Postal Code: | 891620251 |
Phone Number: | 7029305958 |
Fax Number: | 7027969490 |
NPI Enumeration Date: | 01/26/2016 |
NPI Last Update Date: | 01/26/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | MI0633 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NV |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |