Provider Demographics
NPI:1295823482
Name:GREENE, BRENDA L (CRNP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:GREENE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:161 WASHINGTON ST., EIGHT TOWER BRIDGE
Mailing Address - Street 2:STE 1400
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428
Mailing Address - Country:US
Mailing Address - Phone:484-351-3043
Mailing Address - Fax:484-450-2617
Practice Address - Street 1:4090 E GALBRAITH RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2324
Practice Address - Country:US
Practice Address - Phone:513-891-0175
Practice Address - Fax:513-891-0129
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2021-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OHNP1624363L00000X
OHAPRN.CNP.01624363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2346652Medicaid
P67632Medicare UPIN