Nicole Greenlee, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71009094A Issued in IN

Practice address

2824 Elkhart Rd
Goshen, IN 46526-1014

Phone

(574) 535-1700

NPI assigned

May 16, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1557964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610409600000",
    "number": "1093371874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2824 ELKHART RD",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465261014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2824 ELKHART RD",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465261014",
            "telephone_number": "574-535-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENLEE",
        "first_name": "NICOLE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-16",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71009094A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300028207",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "greenlee.nicole.p1@direct.goshenphysicians.nextgenshare.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "2824 Elkhart Rd",
            "city": "Goshen",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465261014",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Susanne Walker Graham, LCSW, MSW
• Cynthia J Grate, LCSW
• Kirstina Jessica Gratz, DDS
• Green Oaks of Goshen, LLC
• Alyssa Green, M.A.
• Mallory A Grossman, NP
• Maire Catherine Grupp, LSW
• Grace Guard
• Jennifer Guardado, FNP
• Paola Guillen

• Family Nurse Practitioner in Goshen, IN
• Providers in Goshen, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.