Provider Demographics
NPI:1285629170
Name:GREENLEE, MICHAEL W (MSRN, FNP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:GREENLEE
Suffix:
Gender:M
Credentials:MSRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 B EBP
Mailing Address - Street 2:200 RIDGE ROAD WEST
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14652-3402
Mailing Address - Country:US
Mailing Address - Phone:585-722-9126
Mailing Address - Fax:585-477-9276
Practice Address - Street 1:28 B EBP
Practice Address - Street 2:200 RIDGE ROAD WEST
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14652-3402
Practice Address - Country:US
Practice Address - Phone:585-722-9126
Practice Address - Fax:585-477-9276
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334395363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q39155Medicare UPIN