Healthcare Provider Details

I. General information

NPI: 1720582109
Provider Name (Legal Business Name): SETH GREENE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20032-2601
US

IV. Provider business mailing address

110 W LOCUST ST
OCCOQUAN VA
22125-7723
US

V. Phone/Fax

Practice location:
  • Phone: 954-309-4927
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN1048020
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: