Provider Demographics
NPI:1912215831
Name:GREENE, DEBRA A
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:A
Last Name:GREENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97-11 HORACE HARDING EXPWY
Mailing Address - Street 2:APT.5B
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368
Mailing Address - Country:US
Mailing Address - Phone:718-592-6798
Mailing Address - Fax:
Practice Address - Street 1:9711 HORACE HARDING EXPY
Practice Address - Street 2:APT.5B
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-4758
Practice Address - Country:US
Practice Address - Phone:718-592-6798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352614-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse