Healthcare Provider Details

I. General information

NPI: 1689542557
Provider Name (Legal Business Name): TYIESHA GREENE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 FAIRFAX AVE APT 2
CINCINNATI OH
45207-1855
US

IV. Provider business mailing address

1614 FAIRFAX AVE APT 2
CINCINNATI OH
45207-1855
US

V. Phone/Fax

Practice location:
  • Phone: 513-659-9133
  • Fax:
Mailing address:
  • Phone: 513-659-9133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number364SA2200X
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: