Provider Demographics
NPI:1639874019
Name:GREEN, SHENA
Entity Type:Individual
Prefix:MRS
First Name:SHENA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3261 OLD WASHINGTON RD STE 2020
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3231
Mailing Address - Country:US
Mailing Address - Phone:301-263-7327
Mailing Address - Fax:888-375-4491
Practice Address - Street 1:3261 OLD WASHINGTON RD STE 2020
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3231
Practice Address - Country:US
Practice Address - Phone:301-263-7327
Practice Address - Fax:888-375-4491
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty