Healthcare Provider Details

I. General information

NPI: 1568786929
Provider Name (Legal Business Name): LINDA GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 SELIM AVE APT 3
CINCINNATI OH
45214-1500
US

IV. Provider business mailing address

2215 SELIM AVE APT 3
CINCINNATI OH
45214-1500
US

V. Phone/Fax

Practice location:
  • Phone: 513-338-9997
  • Fax:
Mailing address:
  • Phone: 513-338-9997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: