Provider Demographics
NPI:1396524153
Name:GREENE, DEONDRALIQUE (NRCMA,CPT)
Entity type:Individual
Prefix:MRS
First Name:DEONDRALIQUE
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:NRCMA,CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 RIVERSIDE PLAZA LN NW STE 118
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2617
Mailing Address - Country:US
Mailing Address - Phone:405-367-9105
Mailing Address - Fax:682-708-2617
Practice Address - Street 1:6300 RIVERSIDE PLAZA LN NW STE 118
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2617
Practice Address - Country:US
Practice Address - Phone:405-367-9105
Practice Address - Fax:682-708-2617
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemaker