Provider Demographics
NPI:1851806798
Name:GREENUP, THERESA LOUISE
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:LOUISE
Last Name:GREENUP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:LOUISE
Other - Last Name:KAMINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2502 E PIKES PEAK AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-6089
Mailing Address - Country:US
Mailing Address - Phone:719-314-2327
Mailing Address - Fax:
Practice Address - Street 1:1980 DOMINION WAY STE 101
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1475
Practice Address - Country:US
Practice Address - Phone:719-358-6428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-13
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO993457363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health