Healthcare Provider Details

I. General information

NPI: 1790646867
Provider Name (Legal Business Name): TAMARA J GREENE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 11/19/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 SOUTHFIELD DR
PLAINFIELD IN
46168-2955
US

IV. Provider business mailing address

3378 FIRETHORN DR
WHITESTOWN IN
46075-8401
US

V. Phone/Fax

Practice location:
  • Phone: 317-914-5956
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71017434A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: