Individual
MRS. JACQUELIN LONDON GREENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
58 CARROLL ST, LEBANON, VA 24266
(276) 883-8086
(276) 883-8090
Mailing address
58 CARROLL ST, LEBANON, VA 24266
(276) 883-8086
(276) 883-8090
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024168638
VA
363LF0000X
Family Nurse Practitioner
14888
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0024168638
VIRGINIA LICENSE
VA
05
—
1124002035
—
VA
05
—
Q003735
—
TN
Enumeration date
12/05/2005
Last updated
02/07/2017
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