Provider Demographics
NPI:1538334107
Name:GREENLEE, DEBRA A
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:GREENLEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72824-0071
Mailing Address - Country:US
Mailing Address - Phone:870-715-7542
Mailing Address - Fax:
Practice Address - Street 1:630 SOUTH RD
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72824-8820
Practice Address - Country:US
Practice Address - Phone:479-493-2862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR163201783Medicaid