Provider Demographics
NPI:1629383963
Name:GREENE, STEPHANIE JILL (APRN-BC)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:JILL
Last Name:GREENE
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-1384
Mailing Address - Country:US
Mailing Address - Phone:937-306-6012
Mailing Address - Fax:
Practice Address - Street 1:65 WOODS EDGE CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-7507
Practice Address - Country:US
Practice Address - Phone:937-366-6699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.320357163W00000X
OHAPRN.CNP.0036376363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse