Healthcare Provider Details

I. General information

NPI: 1073377628
Provider Name (Legal Business Name): DIANE GREENE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N MADISON AVE
ANDERSON IN
46011-3453
US

IV. Provider business mailing address

3624 S GADBURY RD
HARTFORD CITY IN
47348-9740
US

V. Phone/Fax

Practice location:
  • Phone: 765-298-4242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number28209182A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71015366A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: