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General NPI Number Information
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NPI Number | 1336556513
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Entity Type | Organization
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Legal Business Name | DEBORAH S GREENE APRN LLC
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Dates
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Enumeration Date | 07/19/2014
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Last Update Date | 07/19/2014
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Provider Practice Location Address
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Address Line | 760 HOPMEADOW ST BOX 813
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City | SIMSBURY
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State | CT
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Zip | 06070-2223
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Country | US
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Telephone | 860-804-8684
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Fax |
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Provider Business Mailing Address
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Address Line | 760 HOPMEADOW ST BOX 813
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City | SIMSBURY
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State | CT
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Zip | 06070-2223
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Country | US
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Telephone | 860-804-8684
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEBORAH SKINNER GREENE
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Credential | APRN
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Telephone | 860-408-4846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 000837
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License Number State | CT
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