Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 247536 | CA |
NPI | 1063419653 |
---|---|
Provider Name | Carol V Greene |
First Address | Northridge, CA 91324-1139 |
Second Address | Tarzana, CA 91356-3501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 08/07/2007 |