1831198126 NPI number — LAURA M GREENE NP

Table of content: LAURA M GREENE NP (NPI 1831198126)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831198126 NPI number — LAURA M GREENE NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREENE
Provider First Name:
LAURA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831198126
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
483 S LOOP RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDGEWOOD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41017-5446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-301-4600
Provider Business Mailing Address Fax Number:
859-301-4601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
483 S LOOP RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017-5446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-301-4600
Provider Business Practice Location Address Fax Number:
859-301-4601
Provider Enumeration Date:
07/19/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  2778P , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 78009214 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000335133 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".