Provider Demographics
NPI:1760849301
Name:GREENE, CAROLINE (APN)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:RUNNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 LAUREL OAK RD
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4455
Mailing Address - Country:US
Mailing Address - Phone:844-542-2273
Mailing Address - Fax:856-783-1403
Practice Address - Street 1:151 FRIES MILL RD
Practice Address - Street 2:SUITE 301
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-2016
Practice Address - Country:US
Practice Address - Phone:856-374-1881
Practice Address - Fax:856-302-1961
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-27
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015599363LF0000X
NJ26NJ00608400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0505374Medicaid
NJ0505374Medicaid