Provider Demographics
NPI:1689381907
Name:GREENE, JAMIE LYNN (PRSS)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:GREENE
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 PRINCE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-4515
Mailing Address - Country:US
Mailing Address - Phone:304-254-8709
Mailing Address - Fax:
Practice Address - Street 1:345 PRINCE ST STE 1
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4515
Practice Address - Country:US
Practice Address - Phone:304-254-8709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist