Healthcare Provider Details

I. General information

NPI: 1639824584
Provider Name (Legal Business Name): CASSANDRA LYNN GREENE APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASSANDRA ELDERS

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 06/16/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST FL 14
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

251 E HURON ST FL 14
CHICAGO IL
60611-2908
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-9843
  • Fax: 312-926-8119
Mailing address:
  • Phone: 312-926-9843
  • Fax: 312-926-8119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209023212
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209023212
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: