Healthcare Provider Details

I. General information

NPI: 1134423056
Provider Name (Legal Business Name): LUKE GREENE PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2011
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1787 NE KRESKY AVE
CHEHALIS WA
98532-2302
US

IV. Provider business mailing address

1787 NE KRESKY AVE
CHEHALIS WA
98532-2302
US

V. Phone/Fax

Practice location:
  • Phone: 360-506-9212
  • Fax: 360-736-3139
Mailing address:
  • Phone: 360-506-9212
  • Fax: 833-471-4334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60667467.MSL
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number716210
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number22194
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP-AP-60667468-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: