Provider Demographics
NPI:1861871543
Name:GREENE, KATHLEEN J (IBCLC)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:J
Last Name:GREENE
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 MURRAY RD
Mailing Address - Street 2:
Mailing Address - City:MORAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:13118-3546
Mailing Address - Country:US
Mailing Address - Phone:315-515-8496
Mailing Address - Fax:
Practice Address - Street 1:4102 MURRAY RD
Practice Address - Street 2:
Practice Address - City:MORAVIA
Practice Address - State:NY
Practice Address - Zip Code:13118-3546
Practice Address - Country:US
Practice Address - Phone:315-515-8496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10218162163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant