Healthcare Provider Details

I. General information

NPI: 1730060849
Provider Name (Legal Business Name): LIANNA ROSE GREENE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 11/28/2025
Certification Date: 11/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 WAUKEGAN RD
BANNOCKBURN IL
60015-1885
US

IV. Provider business mailing address

293 TIMBER HILL RD
BUFFALO GROVE IL
60089-1984
US

V. Phone/Fax

Practice location:
  • Phone: 847-663-8540
  • Fax:
Mailing address:
  • Phone: 847-903-3091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number041499216
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: