Provider Demographics
NPI:1841550605
Name:GREENE, ERSULAR (RN)
Entity type:Individual
Prefix:
First Name:ERSULAR
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ERSULAR
Other - Middle Name:
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:13681 KITTY HAWK WAY
Mailing Address - Street 2:APT. 301
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-5234
Mailing Address - Country:US
Mailing Address - Phone:989-992-6693
Mailing Address - Fax:
Practice Address - Street 1:13681 KITTY HAWK WAY
Practice Address - Street 2:APT. 301
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-5234
Practice Address - Country:US
Practice Address - Phone:989-992-6693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001235443163W00000X
DCRN1026078163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse