Provider Demographics
NPI:1346966652
Name:MCCARTNEY-GREEN, ALEXIS RENEE
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:RENEE
Last Name:MCCARTNEY-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 1:521 W MOHAWK DR
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:OH
Mailing Address - Zip Code:44644-9643
Mailing Address - Country:US
Mailing Address - Phone:330-312-6170
Mailing Address - Fax:
Practice Address - Street 1:521 W MOHAWK DR
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:OH
Practice Address - Zip Code:44644-9643
Practice Address - Country:US
Practice Address - Phone:330-312-6170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty