Healthcare Provider Details

I. General information

NPI: 1841582475
Provider Name (Legal Business Name): MARIA THERESA GREENE RN202371
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST
DAYTON OH
45409-2722
US

IV. Provider business mailing address

148 SHELFORD WAY
DAYTON OH
45440-3658
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-2766
  • Fax: 937-208-2752
Mailing address:
  • Phone: 937-426-1993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN202371
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: