Provider Demographics
NPI:1306089321
Name:GREEN, ROBERT STEWART (LPN)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:STEWART
Last Name:GREEN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1077 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-1536
Mailing Address - Country:US
Mailing Address - Phone:419-961-7227
Mailing Address - Fax:
Practice Address - Street 1:1077 WOODSIDE DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-1536
Practice Address - Country:US
Practice Address - Phone:419-961-7227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 104655164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse