Provider Demographics
NPI:1396395505
Name:GREEN, KATHRYN C
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:C
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 1:7768 STILLWELL RD APT 2
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-2133
Mailing Address - Country:US
Mailing Address - Phone:513-257-4787
Mailing Address - Fax:
Practice Address - Street 1:7768 STILLWELL RD APT 2
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-2133
Practice Address - Country:US
Practice Address - Phone:513-257-4787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider