Provider Demographics
NPI:1093452088
Name:GREER, ADRIENNE R (CLASS A BARBER)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:R
Last Name:GREER
Suffix:
Gender:F
Credentials:CLASS A BARBER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 FAIR CREST TRL
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-6300
Mailing Address - Country:US
Mailing Address - Phone:214-707-8738
Mailing Address - Fax:
Practice Address - Street 1:1340 N TOWN EAST BLVD STE C
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4148
Practice Address - Country:US
Practice Address - Phone:469-596-8454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX219320335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier