Healthcare Provider Details

I. General information

NPI: 1770760837
Provider Name (Legal Business Name): ERIN ANDREA GREENE CNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 08/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E APPLE ST STE 5254A
DAYTON OH
45409-2939
US

IV. Provider business mailing address

30 E APPLE ST STE 5254A
DAYTON OH
45409-2939
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-4200
  • Fax: 937-208-4205
Mailing address:
  • Phone: 937-208-4200
  • Fax: 937-208-4205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberCOA 09844-NS
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: