Provider Demographics
NPI:1962211722
Name:GREEN, PHYLICIA
Entity type:Individual
Prefix:
First Name:PHYLICIA
Middle Name:
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 1:5252 QUEEN ELIZABETH PL
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-9282
Mailing Address - Country:US
Mailing Address - Phone:614-563-0150
Mailing Address - Fax:
Practice Address - Street 1:5252 QUEEN ELIZABETH PL
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-9282
Practice Address - Country:US
Practice Address - Phone:614-563-0150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health