Provider Demographics
NPI:1497921837
Name:GREENERL, SARAH CHAMBLISS (RN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:CHAMBLISS
Last Name:GREENERL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:VIRGINIA
Other - Last Name:GREENERL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2816 EAGLE ROCK RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-7723
Mailing Address - Country:US
Mailing Address - Phone:804-861-1536
Mailing Address - Fax:
Practice Address - Street 1:20 W BANK ST
Practice Address - Street 2:SUITE 6
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-3279
Practice Address - Country:US
Practice Address - Phone:804-862-8002
Practice Address - Fax:804-862-8060
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001104757163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4945280Medicaid
VA4945280Medicaid