Provider Demographics
NPI:1922523463
Name:GREENING, BRIAN WAYNE (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:WAYNE
Last Name:GREENING
Suffix:
Gender:M
Credentials:APRN, FNP-BC
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 22588
Mailing Address - Street 2:
Mailing Address - City:BARRIGADA
Mailing Address - State:GU
Mailing Address - Zip Code:96921-2588
Mailing Address - Country:US
Mailing Address - Phone:671-645-8360
Mailing Address - Fax:671-649-3872
Practice Address - Street 1:523 CHALAN PASAHERU
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-645-5360
Practice Address - Fax:671-649-3872
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-05
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134667363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily