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General NPI Number Information
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NPI Number | 1780492801
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Entity Type | Individual
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Provider Name | KATHRYN MARIE GREEN LPN
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Gender | Female
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Dates
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Enumeration Date | 12/20/2024
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 580 PARK AVE W
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City | MANSFIELD
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State | OH
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Zip | 44906-3722
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Country | US
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Telephone | 833-510-4357
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 MONTGOMERY RD STE 400
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City | CINCINNATI
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State | OH
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Zip | 45212-3659
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Country | US
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Telephone | 833-510-4357
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LPN.132609.MEDS-IV
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License Number State | OH
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