Provider Demographics
NPI:1942903976
Name:GREENLEES, CAROL
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:GREENLEES
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 1:12 PYRAMID DR APT 1202
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-4053
Mailing Address - Country:US
Mailing Address - Phone:304-617-5854
Mailing Address - Fax:
Practice Address - Street 1:6 SAM COLLINS RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-9774
Practice Address - Country:US
Practice Address - Phone:304-617-5854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider