Provider Demographics
NPI:1053427161
Name:GREENE, JOANNE L (NP)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:L
Last Name:GREENE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 MICHAEL DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-6601
Mailing Address - Country:US
Mailing Address - Phone:937-332-7953
Mailing Address - Fax:
Practice Address - Street 1:275 KIENLE DR
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-4119
Practice Address - Country:US
Practice Address - Phone:937-773-9346
Practice Address - Fax:937-773-9359
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP04890363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00276437OtherRRMEDICARE
OH000000361011OtherBLUE SHIELD
OH2280535Medicaid
OH2280535Medicaid
OH000000361011OtherBLUE SHIELD