Provider Demographics
NPI:1932364197
Name:GREEN, TAMMY L
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2437 KITCHNER DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-2109
Mailing Address - Country:US
Mailing Address - Phone:614-353-9856
Mailing Address - Fax:
Practice Address - Street 1:2437 KITCHNER DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-2109
Practice Address - Country:US
Practice Address - Phone:614-353-9856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-26
Last Update Date:2008-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400727510308374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide