Provider Demographics
NPI:1467794453
Name:GREENE, KATIE (REG NURSE PRACTIT)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:REG NURSE PRACTIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 TROPICANA DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-4277
Mailing Address - Country:US
Mailing Address - Phone:951-509-2990
Mailing Address - Fax:
Practice Address - Street 1:2751 TROPICANA DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-4277
Practice Address - Country:US
Practice Address - Phone:951-509-2990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA256129364SC1501X, 364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health
No364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics