Healthcare Provider Details

I. General information

NPI: 1285192583
Provider Name (Legal Business Name): PATRICIA GREENE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5684 BURNETT RD
LEAVITTSBURG OH
44430-9713
US

IV. Provider business mailing address

5684 BURNETT RD
LEAVITTSBURG OH
44430-9713
US

V. Phone/Fax

Practice location:
  • Phone: 330-766-4719
  • Fax: 234-223-2759
Mailing address:
  • Phone: 330-766-4719
  • Fax: 234-223-2759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.382319
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: