Individual
NICOLE GREENLEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2824 ELKHART RD, GOSHEN, IN 46526-1014
(574) 535-1700
Mailing address
2824 ELKHART RD, GOSHEN, IN 46526-1014
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71009094A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300028207
—
IN
Enumeration date
05/16/2019
Last updated
01/12/2021
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