MEDICARE: MRS. LOIS A GREENE RN,C.

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	163WA2000X	Administrator Registered Nurse	RN495252	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	143308	OTHER	MO	REGISTERED NURSE
2	RN495252	OTHER	FL	REGISTERED NURSE

General Provider Information

NPI Number	:	1811988629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LOIS A GREENE RN,C.

Provider Business Mailing Address
First Line	:	16835 SW 296TH ST
Second Line	:
City	:	HOMESTEAD
State	:	FL
Zip	:	33030-2545
Country	:	US
Telephone Number	:	305-247-3920
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 S DIXIE HWY
Second Line	:	SUITE 402
City	:	MIAMI
State	:	FL
Zip	:	33133-2300
Country	:	US
Telephone Number	:	305-447-2350
Fax Number	:	305-447-2338

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

Provider Enumeration Date	:	11/01/2005
Last Update Date	:	07/08/2007

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