Provider Demographics
NPI:1063890549
Name:GREENE, SALLY W (IBCLC)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:W
Last Name:GREENE
Suffix:
Gender:F
Credentials:IBCLC
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 239
Mailing Address - Street 2:
Mailing Address - City:KAAAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96730-0239
Mailing Address - Country:US
Mailing Address - Phone:808-371-4787
Mailing Address - Fax:
Practice Address - Street 1:51-328B KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:KAAAWA
Practice Address - State:HI
Practice Address - Zip Code:96730-0239
Practice Address - Country:US
Practice Address - Phone:808-371-4787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN