Healthcare Provider Details

I. General information

NPI: 1073555702
Provider Name (Legal Business Name): JOANNE GREENE AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 CHRISTIANA RD NEUROSCIENCE BLDG SUITE B4
NEWARK DE
19713-4236
US

IV. Provider business mailing address

608 BARKER DR
WEST CHESTER PA
19380-6348
US

V. Phone/Fax

Practice location:
  • Phone: 302-266-2449
  • Fax: 302-266-2450
Mailing address:
  • Phone: 484-354-7256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number020000143
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT005943
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: