Provider Demographics
NPI:1497144786
Name:GREENSIDES, RACHAEL (FNP-BC)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:GREENSIDES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4824 E BASELINE RD
Mailing Address - Street 2:3-125
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4676
Mailing Address - Country:US
Mailing Address - Phone:480-839-4848
Mailing Address - Fax:480-833-8310
Practice Address - Street 1:4824 E BASELINE RD
Practice Address - Street 2:3-125
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4676
Practice Address - Country:US
Practice Address - Phone:480-839-4848
Practice Address - Fax:480-833-8310
Is Sole Proprietor?:No
Enumeration Date:2015-01-09
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7550363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily