Provider Demographics
NPI:1215567714
Name:GREENIG, ROBERT (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GREENIG
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 PANCHERI DR STE 4
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-3212
Mailing Address - Country:US
Mailing Address - Phone:208-579-6087
Mailing Address - Fax:888-519-8898
Practice Address - Street 1:1500 PANCHERI DR STE 4
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-3212
Practice Address - Country:US
Practice Address - Phone:208-579-6087
Practice Address - Fax:888-519-8898
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID58629163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse