Provider Demographics
NPI:1639849599
Name:GREENE, JOSHUA D (NP)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:D
Last Name:GREENE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 W RAMPART ST SUITE 200
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-8846
Mailing Address - Country:US
Mailing Address - Phone:317-421-2012
Mailing Address - Fax:317-398-1851
Practice Address - Street 1:2325 INTELLIPLEX DR STE 207
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-8546
Practice Address - Country:US
Practice Address - Phone:317-392-2971
Practice Address - Fax:317-398-1894
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN28233687A363LP0808X
IN71011944A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300058239Medicaid