Provider Demographics
NPI:1134991565
Name:GREEN, DEONAH RENEE
Entity type:Individual
Prefix:
First Name:DEONAH
Middle Name:RENEE
Last Name:GREEN
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 1:730 SOUTHBRIAR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-2558
Mailing Address - Country:US
Mailing Address - Phone:419-860-2891
Mailing Address - Fax:
Practice Address - Street 1:730 SOUTHBRIAR RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607-2558
Practice Address - Country:US
Practice Address - Phone:419-860-2891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty