Individual
MRS. MARY ELIZABETH GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
650 HIGHLAND AVE # 100, WINSTON SALEM, NC 27101-4304
(336) 607-8523
(336) 773-0914
Mailing address
284 EXECUTIVE PARK DR STE 100, CONCORD, NC 28025-1833
(704) 939-1100
(704) 939-1173
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
76633
NC
Other
Enumeration date
10/30/2019
Last updated
10/30/2019
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