Provider Demographics
NPI:1083400667
Name:GREENE, JOCALYN ELIZABETH
Entity type:Individual
Prefix:
First Name:JOCALYN
Middle Name:ELIZABETH
Last Name:GREENE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:JOCALYN
Other - Middle Name:ELIZABETH
Other - Last Name:EMSLANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2226 LAKE PARK DR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-9205
Mailing Address - Country:US
Mailing Address - Phone:303-887-0717
Mailing Address - Fax:
Practice Address - Street 1:4747 ARAPAHOE AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1131
Practice Address - Country:US
Practice Address - Phone:303-415-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1626110163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse