Provider Demographics
NPI:1033294681
Name:GREENLEE, CAROL S (CNM)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:S
Last Name:GREENLEE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:402-499-6641
Mailing Address - Fax:
Practice Address - Street 1:301 S 70TH ST STE 200
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2452
Practice Address - Country:US
Practice Address - Phone:402-483-7641
Practice Address - Fax:402-483-0527
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9565380-4402176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-0546525-12Medicaid
279626Medicare ID - Type Unspecified
NE47-0546525-12Medicaid