Healthcare Provider Details

I. General information

NPI: 1861358525
Provider Name (Legal Business Name): ANDREA GREENE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2025
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MONTANA AVE STE 245
CINCINNATI OH
45211-3829
US

IV. Provider business mailing address

526 THORNTON ST APT 1
NEWPORT KY
41071-4753
US

V. Phone/Fax

Practice location:
  • Phone: 513-978-1451
  • Fax:
Mailing address:
  • Phone: 513-978-1451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: