Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | A70569 | CA |
N | 207Q00000X | Family Doctor | MD2010-0804 | NM |
N | 207QA0401X | Family Doctor - Addiction Medicine | A70569 | CA |
N | 207QA0401X | Family Doctor - Addiction Medicine | MD2010-0804 | NM |
NPI | 1477665867 |
---|---|
Provider Name | Dr. Denise E. Greene |
First Address | Alamogordo, NM 88310-8700 |
Second Address | Alamogordo, NM 88310-8700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 27/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H69577 | (02) | CA |