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
State | License ID | Taxonomies |
---|---|---|
PA | RN558963 | 367A00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 367A00000X | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | RN558963 | Other | REGISTERED NURSE |
PA | 102248310 | Medicaid | |
PA | MW010193 | Other | CERTIFIED NURSE MIDWIFE |
1942447941 | Other | NPI | |
144038ESC | Medicare PIN |