Provider Demographics
NPI:1609116102
Name:GREENE, KELLY PAGE (RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:PAGE
Last Name:GREENE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-2855
Mailing Address - Country:US
Mailing Address - Phone:843-774-1219
Mailing Address - Fax:843-841-3689
Practice Address - Street 1:405 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-2855
Practice Address - Country:US
Practice Address - Phone:843-774-1219
Practice Address - Fax:843-841-3689
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC54707163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool