Provider Demographics
NPI:1235517244
Name:GREENE, RITA (FNP-C)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:
Other - Last Name:NEELEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10097
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85130-0020
Mailing Address - Country:US
Mailing Address - Phone:520-836-3446
Mailing Address - Fax:
Practice Address - Street 1:44572 W BOWLIN RD
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-4558
Practice Address - Country:US
Practice Address - Phone:520-568-2245
Practice Address - Fax:520-568-2316
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP 60502642363LF0000X
AZ240170363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1235517244Medicaid