Basic Information
Provider Information
NPI: 1255985743
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GREENE
FirstName: RACHEL
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 210127
Address2:  
City: NASHVILLE
State: TN
PostalCode: 372210127
CountryCode: US
TelephoneNumber: 6153832443
FaxNumber: 6153830853
Practice Location
Address1: 330 22ND AVE N
Address2:  
City: NASHVILLE
State: TN
PostalCode: 372031844
CountryCode: US
TelephoneNumber: 6153200007
FaxNumber: 6159023980
Other Information
ProviderEnumerationDate: 08/01/2019
LastUpdateDate: 02/20/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/20/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X189412TNN Nursing Service ProvidersRegistered Nurse 
363L00000X26275TNY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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