Healthcare Provider Details

I. General information

NPI: 1174592232
Provider Name (Legal Business Name): WILLIAM F GREEN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MATTHEW ST
MARIETTA OH
45750-1635
US

IV. Provider business mailing address

197 MASONIC PARK RD
MARIETTA OH
45750-1028
US

V. Phone/Fax

Practice location:
  • Phone: 740-376-9990
  • Fax: 740-376-9993
Mailing address:
  • Phone: 407-885-9322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.08602
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: