Provider Demographics
NPI:1902668577
Name:GREENE, DEMARIS DOROUGH (RN)
Entity Type:Individual
Prefix:MRS
First Name:DEMARIS
Middle Name:DOROUGH
Last Name:GREENE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 CLEAR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:AL
Mailing Address - Zip Code:35014-6084
Mailing Address - Country:US
Mailing Address - Phone:205-705-6331
Mailing Address - Fax:
Practice Address - Street 1:1050 CLEAR CREEK DR
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:AL
Practice Address - Zip Code:35014-6084
Practice Address - Country:US
Practice Address - Phone:205-705-6331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-177827390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program