Liza M Greene, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601007430 Issued in MI

Practice address

1091 S Beacon Blvd
Grand Haven, MI 49417-2607

Phone

(616) 604-0096

NPI assigned

Feb 12, 2007

Last updated

Aug 7, 2015By the provider in NPPES

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Interoperability endpoints

• Direct secure messaging: liza.greene.1@30520.direct.athenahealth.com

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438905600000",
    "number": "1376684100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 WISCONSIN AVE",
            "address_2": "SUITE 101",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494172472",
            "telephone_number": "616-844-4528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1091 S BEACON BLVD",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494172607",
            "telephone_number": "616-604-0096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENE",
        "first_name": "LIZA",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-12",
        "last_updated": "2015-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601007430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "0010-00802",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI LICENSE",
            "identifier": "5601007430",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Grand Pines Assisted Living Center
• Emily Gray
• Great Lakes Chiropractic Health (Great Lakes Health & Wellness of Grand Haven)
• Great Lakes Compounding Pharmacy
• Great Lakes Physical Therapies, LLC
• Sharon Lynn Griswold, L.M.S.W.
• Mallory Groenevelt
• Sara Grossenbacher, OT
• Susan Hackney, RPH
• Stanley Haegert, MD

• Physician Assistant in Grand Haven, MI
• Providers in Grand Haven, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2015; 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.