Provider Demographics
NPI:1851524995
Name:GREENHOUSE, KIMBERLY CORINNE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:CORINNE
Last Name:GREENHOUSE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:CORINNE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3115 COLLEGE PARK DR.
Mailing Address - Street 2:#104
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384
Mailing Address - Country:US
Mailing Address - Phone:936-321-5030
Mailing Address - Fax:936-271-5033
Practice Address - Street 1:3115 COLLEGE PARK DR.
Practice Address - Street 2:#104 FOREST PEDIATRICS
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384
Practice Address - Country:US
Practice Address - Phone:936-321-5030
Practice Address - Fax:936-271-5033
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX222565163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse