Provider Demographics
NPI:1922889237
Name:GREENE, JESSICA RENEE (RN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE
Last Name:GREENE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37081 GOATS RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-9789
Mailing Address - Country:US
Mailing Address - Phone:541-912-4092
Mailing Address - Fax:
Practice Address - Street 1:988 WEST A STREET
Practice Address - Street 2:
Practice Address - City:CRESWELL
Practice Address - State:OR
Practice Address - Zip Code:97426
Practice Address - Country:US
Practice Address - Phone:541-895-6197
Practice Address - Fax:541-895-6199
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200842212RN163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool