Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 9565380-4402 | UT |
NPI | 1033294681 |
---|---|
Provider Name | Mrs. Carol S Greenlee |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | Lincoln, NE 68510-2452 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 16/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47-0546525-12 | (05) | NE |
Q03830 | (02) |