Provider Demographics
NPI:1528712759
Name:GREENLY, BRIANNA (NP)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:GREENLY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1277 KETTNER BLVD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-3381
Mailing Address - Country:US
Mailing Address - Phone:916-847-0815
Mailing Address - Fax:
Practice Address - Street 1:6125 PASEO DEL NORTE STE 200
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1113
Practice Address - Country:US
Practice Address - Phone:760-585-2662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019110363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty