Provider Demographics
NPI:1891969481
Name:GREENLEE, SHARON S
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:S
Last Name:GREENLEE
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 1:9474 N 1900TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:IL
Mailing Address - Zip Code:62477-2240
Mailing Address - Country:US
Mailing Address - Phone:217-826-5788
Mailing Address - Fax:
Practice Address - Street 1:9474 N 1900TH ST
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:IL
Practice Address - Zip Code:62477-2240
Practice Address - Country:US
Practice Address - Phone:217-826-5788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1485297172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver