Individual
ELIZABETH A GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2404 WISE RD, CONWAY, SC 29526-5521
(843) 655-9432
Mailing address
972 DESERT WHEATGRASS DR, MYRTLE BEACH, SC 29579-3584
(518) 312-6634
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
305848
NY
363LA2200X
Adult Health Nurse Practitioner
F305848
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
24243
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03391691
—
NY
Enumeration date
10/11/2011
Last updated
05/18/2022
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