Provider Demographics
NPI:1568403798
Name:GREENLEAF, JAMES S (APRN,CNS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:S
Last Name:GREENLEAF
Suffix:
Gender:M
Credentials:APRN,CNS
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 547
Mailing Address - Street 2:CENTRAL VERMONT MEDICAL CENTER - FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-225-1266
Mailing Address - Fax:802-479-3548
Practice Address - Street 1:82 E VIEW LANE STE 3
Practice Address - Street 2:FAMILY PSYCHIATRY ASSOCIATES
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9516
Practice Address - Country:US
Practice Address - Phone:802-225-1266
Practice Address - Fax:802-479-3548
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0020287163W00000X
VT101.0020287363LP0808X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTORE3606Medicaid
NS2024Medicare ID - Type Unspecified
VTUX9591Medicare PIN
VTORE3606Medicaid
R92000Medicare PIN