Provider Demographics
NPI:1851844310
Name:GREEN, MADENA LESA (LPN)
Entity Type:Individual
Prefix:
First Name:MADENA
Middle Name:LESA
Last Name:GREEN
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 1:9978 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:OLMSTED FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44138-2702
Mailing Address - Country:US
Mailing Address - Phone:216-310-4976
Mailing Address - Fax:
Practice Address - Street 1:9978 MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:OLMSTED FALLS
Practice Address - State:OH
Practice Address - Zip Code:44138-2702
Practice Address - Country:US
Practice Address - Phone:216-310-4976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.128018-MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse