Provider Demographics
NPI:1942579719
Name:RILEY-GREENWOOD, DENISE MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:MARIE
Last Name:RILEY-GREENWOOD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:MARIE
Other - Last Name:RILEY-CALDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:923 CUSTER ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1211
Mailing Address - Country:US
Mailing Address - Phone:516-599-0467
Mailing Address - Fax:516-599-0467
Practice Address - Street 1:923 CUSTER ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-1211
Practice Address - Country:US
Practice Address - Phone:516-599-0467
Practice Address - Fax:516-599-0467
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308711-1164W00000X
CT034080164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse