Provider Demographics
NPI:1083267702
Name:GREENBERG, GREGORY ADRIAN (AGCNS-BC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ADRIAN
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:AGCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 COLETO ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702
Mailing Address - Country:US
Mailing Address - Phone:610-716-9159
Mailing Address - Fax:
Practice Address - Street 1:1301 W 38TH ST STE 403
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1013
Practice Address - Country:US
Practice Address - Phone:512-593-7902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142303364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP142303OtherTEXAS STATE BOARD OF NURSING