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General NPI Number Information
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NPI Number | 1861587024
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Entity Type | Individual
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Provider Name | JUDITH KATHRYN GREENE
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/30/2007
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Provider Practice Location Address
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Address Line | 225 HOPMEADOW ST SUITE # 100
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City | WEATOGUE
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State | CT
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Zip | 06089-9782
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Country | US
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Telephone | 860-658-0465
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Fax |
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Provider Business Mailing Address
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Address Line | 10 SACHEMS TRL PO BOX 383
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City | WEST SIMSBURY
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State | CT
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Zip | 06092-2525
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Country | US
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Telephone | 860-651-8428
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 002331
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License Number State | CT
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