Provider Demographics
NPI:1255876363
Name:GREENE, MARIJANE SUE (LPN)
Entity type:Individual
Prefix:MS
First Name:MARIJANE
Middle Name:SUE
Last Name:GREENE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40500 WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:OH
Mailing Address - Zip Code:44050-9415
Mailing Address - Country:US
Mailing Address - Phone:440-752-8011
Mailing Address - Fax:
Practice Address - Street 1:40500 WEBSTER RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:OH
Practice Address - Zip Code:44050-9415
Practice Address - Country:US
Practice Address - Phone:440-752-8011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH123885164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse