Provider Demographics
NPI:1689184947
Name:GREENE, CRYSTAL (DNP CRNP)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:DNP CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5610 GWYNNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-6145
Mailing Address - Country:US
Mailing Address - Phone:443-410-3570
Mailing Address - Fax:443-410-3592
Practice Address - Street 1:2 CRAIN HWY S
Practice Address - Street 2:# 2B
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3526
Practice Address - Country:US
Practice Address - Phone:410-281-2566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-01
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR137229363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health