Provider Demographics
NPI:1437793387
Name:GREENE, CARRIE A (CNP)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:A
Last Name:GREENE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3745 SHAWNEE RD STE 108
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45806-1665
Mailing Address - Country:US
Mailing Address - Phone:419-879-9394
Mailing Address - Fax:419-812-2608
Practice Address - Street 1:3745 SHAWNEE RD STE 108
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45806-1665
Practice Address - Country:US
Practice Address - Phone:419-879-9394
Practice Address - Fax:419-812-2608
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.025896363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily