Provider Demographics
NPI:1619190485
Name:GREENE, JEANNE LOUISE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:LOUISE
Last Name:GREENE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT HARBOR
Mailing Address - State:OH
Mailing Address - Zip Code:44077-5640
Mailing Address - Country:US
Mailing Address - Phone:440-354-8029
Mailing Address - Fax:
Practice Address - Street 1:432 INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:FAIRPORT HARBOR
Practice Address - State:OH
Practice Address - Zip Code:44077-5640
Practice Address - Country:US
Practice Address - Phone:440-354-8029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN292557163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2655998Medicaid