Provider Demographics
NPI:1164463782
Name:GREENE, BRENDA R (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:R
Last Name:GREENE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:R
Other - Last Name:ROTHSCHILD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 6329
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-6329
Mailing Address - Country:US
Mailing Address - Phone:847-549-6473
Mailing Address - Fax:847-549-1646
Practice Address - Street 1:1800 HOLLISTER DR
Practice Address - Street 2:SUITE 202
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5263
Practice Address - Country:US
Practice Address - Phone:847-549-6473
Practice Address - Fax:847-549-1646
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant