Healthcare Provider Details

I. General information

NPI: 1740019082
Provider Name (Legal Business Name): DAWN MARIE GREENE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 LILLY RD NE
OLYMPIA WA
98506-5133
US

IV. Provider business mailing address

7541 CHINOOK ST NE
LACEY WA
98516-9353
US

V. Phone/Fax

Practice location:
  • Phone: 360-491-9480
  • Fax:
Mailing address:
  • Phone: 941-320-7236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9179320
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: