Provider Demographics
NPI:1992861579
Name:FETNER-GREENBERG, LOIS GAIL
Entity Type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:GAIL
Last Name:FETNER-GREENBERG
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 1:20950 VIA JASMINE
Mailing Address - Street 2:UNIT # 3
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1324
Mailing Address - Country:US
Mailing Address - Phone:561-488-4722
Mailing Address - Fax:
Practice Address - Street 1:20950 VIA JASMINE
Practice Address - Street 2:UNIT # 3
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1324
Practice Address - Country:US
Practice Address - Phone:561-488-4722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9516171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor