Provider Demographics
NPI:1154488203
Name:GRENINGER, LINDA WILLIAMS (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:WILLIAMS
Last Name:GRENINGER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2083
Mailing Address - Country:US
Mailing Address - Phone:336-274-1237
Mailing Address - Fax:336-335-5710
Practice Address - Street 1:301 N ELM ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2083
Practice Address - Country:US
Practice Address - Phone:336-274-1237
Practice Address - Fax:336-335-5710
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC070921163W00000X
NC600084363LA2200X, 363LG0600X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005042Medicaid
NC2592168Medicare ID - Type Unspecified
NCP25768Medicare UPIN