Provider Demographics
NPI:1124029822
Name:GREENE, TRESHELL NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:TRESHELL
Middle Name:NICOLE
Last Name:GREENE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TRESHELL
Other - Middle Name:RAMBOUT
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-637-3373
Mailing Address - Fax:704-637-0069
Practice Address - Street 1:650 JULIAN RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-9078
Practice Address - Country:US
Practice Address - Phone:704-637-3373
Practice Address - Fax:704-637-0069
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102226363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101752Medicaid
NC8101752Medicaid
NC2742960AMedicare PIN
NCS30147Medicare UPIN