Provider Demographics
NPI:1760734958
Name:GREENE, REBECCA NOEL (LPN)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:NOEL
Last Name:GREENE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3979 CLAIRE LN
Mailing Address - Street 2:P.O. BOX 1691
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-7606
Mailing Address - Country:US
Mailing Address - Phone:423-748-9705
Mailing Address - Fax:
Practice Address - Street 1:3979 CLAIRE LN
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-7606
Practice Address - Country:US
Practice Address - Phone:423-748-9705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN81850164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse