Provider Demographics
NPI:1740608694
Name:GREENE, COURTNEY (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 MOUNT HOPE RD
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-9760
Mailing Address - Country:US
Mailing Address - Phone:716-335-1675
Mailing Address - Fax:
Practice Address - Street 1:4519 MILITARY RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14305-1335
Practice Address - Country:US
Practice Address - Phone:716-304-5006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF35679201363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily