Provider Demographics
NPI:1225040488
Name:GREENSTREET, NANCY L (MD)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:L
Last Name:GREENSTREET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1595 SOQUEL DR STE 330
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1722
Mailing Address - Country:US
Mailing Address - Phone:831-465-7761
Mailing Address - Fax:831-475-1156
Practice Address - Street 1:528 CAPITOLA AVE
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2750
Practice Address - Country:US
Practice Address - Phone:831-475-1630
Practice Address - Fax:831-475-1629
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG73019207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0028551Medicaid
CAF18310Medicare UPIN
CAGR0028551Medicaid