Provider Demographics
NPI:1609332592
Name:GREENE, CHRYSTAL RENEE (LPN)
Entity Type:Individual
Prefix:
First Name:CHRYSTAL
Middle Name:RENEE
Last Name:GREENE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 WOODHILL
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-2047
Mailing Address - Country:US
Mailing Address - Phone:315-359-1967
Mailing Address - Fax:
Practice Address - Street 1:1035 WOODHILL
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-2047
Practice Address - Country:US
Practice Address - Phone:315-359-1967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY327579-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse