Healthcare Provider Details

I. General information

NPI: 1932364197
Provider Name (Legal Business Name): TAMMY L GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2008
Last Update Date: 07/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2437 KITCHNER DR
COLUMBUS OH
43207-2109
US

IV. Provider business mailing address

2437 KITCHNER DR
COLUMBUS OH
43207-2109
US

V. Phone/Fax

Practice location:
  • Phone: 614-353-9856
  • Fax:
Mailing address:
  • Phone: 614-353-9856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number400727510308
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number400727510308
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: