Healthcare Provider Details

I. General information

NPI: 1275956617
Provider Name (Legal Business Name): JOHN WESLEY GREENE CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2014
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1036 S VERITY PKWY
MIDDLETOWN OH
45044-5513
US

IV. Provider business mailing address

PO BOX 837
HAMILTON OH
45012-0837
US

V. Phone/Fax

Practice location:
  • Phone: 513-425-8305
  • Fax: 513-425-1810
Mailing address:
  • Phone: 513-454-1111
  • Fax: 513-454-1484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.15565
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: