Healthcare Provider Details

I. General information

NPI: 1952870214
Provider Name (Legal Business Name): STEPHANIE RAE GREEN I RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 CONSIDINE AVE
CINCINNATI OH
45204-1604
US

IV. Provider business mailing address

1935 CRUEY LN
BATAVIA OH
45103-8494
US

V. Phone/Fax

Practice location:
  • Phone: 513-363-6021
  • Fax:
Mailing address:
  • Phone: 513-545-8860
  • Fax: 513-363-6020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number304839
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: