Provider Demographics
NPI:1861733347
Name:GREENOUGH, STEPHANIE MARION
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARION
Last Name:GREENOUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MARION
Other - Last Name:KARP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43 COOLIDGE PT
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01944-1605
Mailing Address - Country:US
Mailing Address - Phone:978-587-7846
Mailing Address - Fax:
Practice Address - Street 1:43 COOLIDGE PT
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01944-1605
Practice Address - Country:US
Practice Address - Phone:978-587-7846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program