Provider Demographics
NPI:1659923019
Name:GREENFIELD, VIVIAN LEE
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:LEE
Last Name:GREENFIELD
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:PO BOX 153
Mailing Address - Street 2:
Mailing Address - City:ILION
Mailing Address - State:NY
Mailing Address - Zip Code:13357-0153
Mailing Address - Country:US
Mailing Address - Phone:315-868-5933
Mailing Address - Fax:
Practice Address - Street 1:100 SEYMOUR RD
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-1311
Practice Address - Country:US
Practice Address - Phone:315-792-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0266084363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily