Provider Demographics
NPI:1376152637
Name:GREENE, JENNY RENAE (BSP1)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:RENAE
Last Name:GREENE
Suffix:
Gender:F
Credentials:BSP1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 CLIFF RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:WV
Mailing Address - Zip Code:25260-9100
Mailing Address - Country:US
Mailing Address - Phone:304-593-3428
Mailing Address - Fax:
Practice Address - Street 1:225 6TH ST
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-1108
Practice Address - Country:US
Practice Address - Phone:304-273-9311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant