Provider Demographics
NPI:1467106872
Name:GREENE, GEURIN SARA (THW)
Entity Type:Individual
Prefix:
First Name:GEURIN
Middle Name:SARA
Last Name:GREENE
Suffix:
Gender:F
Credentials:THW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-4244
Mailing Address - Country:US
Mailing Address - Phone:458-223-1881
Mailing Address - Fax:
Practice Address - Street 1:125 S WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-4244
Practice Address - Country:US
Practice Address - Phone:458-223-1881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-05
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR106180OtherOREGON TRADITIONAL HEALTH WORKER REGISTRY