Provider Demographics
NPI:1649403841
Name:GREENLICK, LUELLEN ANN (NP)
Entity Type:Individual
Prefix:
First Name:LUELLEN
Middle Name:ANN
Last Name:GREENLICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2428 ALLEGRETTO AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-6640
Mailing Address - Country:US
Mailing Address - Phone:702-612-1164
Mailing Address - Fax:
Practice Address - Street 1:8480 S EASTERN AVE STE F
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2822
Practice Address - Country:US
Practice Address - Phone:702-914-6900
Practice Address - Fax:702-914-6904
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV000646364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100519111Medicaid