Individual
HEATHER M GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
121 PARK CENTRAL DR, SUITE 200, COLUMBIA, SC 29203-6476
(803) 252-9907
(803) 252-9906
Mailing address
121 PARK CENTRAL DR, SUITE 200, COLUMBIA, SC 29203-6476
(803) 252-9907
(803) 252-9906
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
AC4454
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AC4454
ACNP LICENSE
SC
Enumeration date
02/18/2011
Last updated
08/31/2017
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