Provider Demographics
NPI:1801145065
Name:GREENE, NICOLE (CPM)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 45086
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64171-8086
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 W 34TH ST
Practice Address - Street 2:2
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-1315
Practice Address - Country:US
Practice Address - Phone:319-572-1152
Practice Address - Fax:816-817-6603
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife