Healthcare Provider Details

I. General information

NPI: 1235068420
Provider Name (Legal Business Name): MICHELLE THERESA GREENMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 VINE ST
SANDUSKY OH
44870-3234
US

IV. Provider business mailing address

1224 VINE ST
SANDUSKY OH
44870-3234
US

V. Phone/Fax

Practice location:
  • Phone: 419-515-7997
  • Fax:
Mailing address:
  • Phone: 419-515-7997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: