Individual
STACEY M GREENUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PPCNP
Contact information
Practice address
700 CHILDRENS DR, NATIONWIDE CHILDREN'S HOSPITAL-CTICU, COLUMBUS, OH 43205-2664
(614) 722-9042
Mailing address
2012 GARFIELD AVE, SUITE B, PARKERSBURG, WV 26101-2527
(304) 893-9090
(304) 893-9113
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
2011009651
OH
363LP0200X
Pediatric Nurse Practitioner
Primary
APRN86910-PPCNP-BC
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810028858
—
WV
Enumeration date
01/30/2012
Last updated
09/04/2015
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