Provider Demographics
NPI:1730202920
Name:GREEN, DANA
Entity type:Individual
Prefix:
First Name:DANA
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 1:13607 SAYBROOK AVE
Mailing Address - Street 2:GARFEILD
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44105-7021
Mailing Address - Country:US
Mailing Address - Phone:216-862-0211
Mailing Address - Fax:
Practice Address - Street 1:13607 SAYBROOK AVE
Practice Address - Street 2:GARFEILD
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44105-7021
Practice Address - Country:US
Practice Address - Phone:216-862-0211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2664120Medicaid