Provider Demographics
NPI:1194747568
Name:GREENE, JUDITH (MSN)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-3636
Mailing Address - Country:US
Mailing Address - Phone:615-278-2241
Mailing Address - Fax:615-904-9182
Practice Address - Street 1:1855 EXECUTIVE PARK NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-2735
Practice Address - Country:US
Practice Address - Phone:423-479-5454
Practice Address - Fax:423-339-3421
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5071363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3345569Medicare ID - Type Unspecified