Provider Demographics
NPI:1568847655
Name:WAUCHOPE-GREENLAND, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WAUCHOPE-GREENLAND
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 1:275 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3101
Mailing Address - Country:US
Mailing Address - Phone:914-224-3285
Mailing Address - Fax:
Practice Address - Street 1:275 FIFTH STREET
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543
Practice Address - Country:US
Practice Address - Phone:914-224-3285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5064821163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse