Provider Demographics
NPI:1811724891
Name:GREENE, HEATHER DEANNE (FNP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:DEANNE
Last Name:GREENE
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 632476
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2476
Mailing Address - Country:US
Mailing Address - Phone:423-433-6630
Mailing Address - Fax:423-232-8574
Practice Address - Street 1:314 ROGOSIN DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2904
Practice Address - Country:US
Practice Address - Phone:423-433-6630
Practice Address - Fax:423-232-8574
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37107363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily