Provider Demographics
NPI:1689276529
Name:GREENSPAN, JUDI KEENE
Entity Type:Individual
Prefix:
First Name:JUDI
Middle Name:KEENE
Last Name:GREENSPAN
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 1:20560 SHELBURNE RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1941
Mailing Address - Country:US
Mailing Address - Phone:216-932-1989
Mailing Address - Fax:216-906-7293
Practice Address - Street 1:20560 SHELBURNE RD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-1941
Practice Address - Country:US
Practice Address - Phone:216-932-1989
Practice Address - Fax:216-371-5443
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH347C00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No347C00000XTransportation ServicesPrivate Vehicle