Provider Demographics
NPI:1285192583
Name:GREENE, PATRICIA (RN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5684 BURNETT RD
Mailing Address - Street 2:
Mailing Address - City:LEAVITTSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44430-9713
Mailing Address - Country:US
Mailing Address - Phone:330-766-4719
Mailing Address - Fax:234-223-2759
Practice Address - Street 1:5684 BURNETT RD
Practice Address - Street 2:
Practice Address - City:LEAVITTSBURG
Practice Address - State:OH
Practice Address - Zip Code:44430-9713
Practice Address - Country:US
Practice Address - Phone:330-766-4719
Practice Address - Fax:234-223-2759
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.382319163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse