Provider Demographics
NPI:1457119737
Name:GREENLEE, BREYONA MENYON
Entity Type:Individual
Prefix:
First Name:BREYONA
Middle Name:MENYON
Last Name:GREENLEE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BREYONA
Other - Middle Name:MENYON
Other - Last Name:GREENLEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BREYONA GREENLEE
Mailing Address - Street 1:6931 E 15TH PL APT 119
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-7405
Mailing Address - Country:US
Mailing Address - Phone:918-991-0356
Mailing Address - Fax:
Practice Address - Street 1:6216 S LEWIS AVE STE 102
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1075
Practice Address - Country:US
Practice Address - Phone:918-960-7852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator