MEDICARE: MRS. JANENA D GREEN LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	PN 129562	OH

General Provider Information

NPI Number	:	1639304306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANENA D GREEN LPN

Provider Business Mailing Address
First Line	:	238 S CONOVER ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45402-8215
Country	:	US
Telephone Number	:	937-301-6346
Fax Number	:

Provider Business Practice Location Address
First Line	:	238 S CONOVER ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45402-8215
Country	:	US
Telephone Number	:	937-301-6346
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2009
Last Update Date	:	05/23/2009

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