Provider Demographics
NPI:1235714528
Name:GREENLEE, DENISE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:GREENLEE
Suffix:
Gender:F
Credentials:
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 160
Mailing Address - Street 2:
Mailing Address - City:TUNNELTON
Mailing Address - State:WV
Mailing Address - Zip Code:26444-0160
Mailing Address - Country:US
Mailing Address - Phone:304-568-2054
Mailing Address - Fax:
Practice Address - Street 1:405 GIBSON STREET
Practice Address - Street 2:
Practice Address - City:TUNNELTON
Practice Address - State:WV
Practice Address - Zip Code:26444
Practice Address - Country:US
Practice Address - Phone:304-568-2054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker