Provider Demographics
NPI:1164703997
Name:GREENE, DELORES
Entity Type:Individual
Prefix:
First Name:DELORES
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 1:1234 HILDRETH AVE
Mailing Address - Street 2:P.O. BOX 83502
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43203-1547
Mailing Address - Country:US
Mailing Address - Phone:614-832-0989
Mailing Address - Fax:614-388-5554
Practice Address - Street 1:1374 KING AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-2271
Practice Address - Country:US
Practice Address - Phone:614-832-0989
Practice Address - Fax:614-388-5554
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor