Provider Demographics
NPI:1063826303
Name:MACKENZIE-GREENLE, MEREDITH ANN (PHD, RN, ANP-BC, CNE)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:ANN
Last Name:MACKENZIE-GREENLE
Suffix:
Gender:F
Credentials:PHD, RN, ANP-BC, CNE
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Other - Suffix:
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Mailing Address - Street 1:2641 SALMON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-4012
Mailing Address - Country:US
Mailing Address - Phone:814-282-6296
Mailing Address - Fax:
Practice Address - Street 1:2641 SALMON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-4012
Practice Address - Country:US
Practice Address - Phone:814-282-6296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-14
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013982363LA2200X
PARN585565163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse