Provider Demographics
NPI:1942447941
Name:GREENE, TONJA H M (CNM)
Entity Type:Individual
Prefix:
First Name:TONJA
Middle Name:H M
Last Name:GREENE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 HIGHLANDS DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-7507
Mailing Address - Country:US
Mailing Address - Phone:888-393-1338
Mailing Address - Fax:717-627-1817
Practice Address - Street 1:1575 HIGHLANDS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-7507
Practice Address - Country:US
Practice Address - Phone:888-393-1338
Practice Address - Fax:717-627-1817
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN558963367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN558963OtherREGISTERED NURSE
PA102248310Medicaid
PAMW010193OtherCERTIFIED NURSE MIDWIFE
1942447941OtherNPI
144038ESCMedicare PIN