Individual
DAPHNE RUSS GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
305 SOUTH MAIN STREET, BLADENBORO, NC 28320
(910) 770-1514
Mailing address
305 SOUTH MAIN STREET, BLADENBORO, NC 28320
(910) 809-0082
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
5014060
NC
Other
Enumeration date
03/23/2021
Last updated
05/25/2021
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