Provider Demographics
NPI:1902564123
Name:GREENE, MEGAN ELIZABETH WALL
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELIZABETH WALL
Last Name:GREENE
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 1:506 CASAR BELWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:NC
Mailing Address - Zip Code:28090-8201
Mailing Address - Country:US
Mailing Address - Phone:336-209-9407
Mailing Address - Fax:
Practice Address - Street 1:217 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GROVER
Practice Address - State:NC
Practice Address - Zip Code:28073-9553
Practice Address - Country:US
Practice Address - Phone:704-457-4075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-05
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCGREE-D6DSF363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily