Provider Demographics
NPI:1073799003
Name:NANCY GREEN INC.
Entity Type:Organization
Organization Name:NANCY GREEN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:DESORMEAU
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:704-633-9747
Mailing Address - Street 1:P.O. BOX 1762
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-9489
Mailing Address - Country:US
Mailing Address - Phone:704-633-9747
Mailing Address - Fax:704-633-9608
Practice Address - Street 1:121 RUGBY RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-9489
Practice Address - Country:US
Practice Address - Phone:704-633-9747
Practice Address - Fax:704-633-9608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC175133302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization