Provider Demographics
NPI:1245746437
Name:GREEN, JANIE ELIZABETH
Entity Type:Individual
Prefix:
First Name:JANIE
Middle Name:ELIZABETH
Last Name:GREEN
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 1:934 LOVE HILL RD
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:WV
Mailing Address - Zip Code:26184-3264
Mailing Address - Country:US
Mailing Address - Phone:304-679-7454
Mailing Address - Fax:
Practice Address - Street 1:934 LOVE HILL RD
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:WV
Practice Address - Zip Code:26184-3264
Practice Address - Country:US
Practice Address - Phone:304-679-7454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant