Provider Demographics
NPI:1124568282
Name:GREENE, MELON
Entity Type:Individual
Prefix:MS
First Name:MELON
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6508 S LAFLIN ST APT 101
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60636-2812
Mailing Address - Country:US
Mailing Address - Phone:773-632-6858
Mailing Address - Fax:
Practice Address - Street 1:6508 S LAFLIN ST APT 101
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60636-2812
Practice Address - Country:US
Practice Address - Phone:773-632-6858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide