Provider Demographics
NPI:1164707196
Name:GREEN, SHIRLEY MAE (RNBSN)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:MAE
Last Name:GREEN
Suffix:
Gender:F
Credentials:RNBSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7912 WHIMBREL LN
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-5409
Mailing Address - Country:US
Mailing Address - Phone:919-552-6113
Mailing Address - Fax:
Practice Address - Street 1:7912 WHIMBREL LN
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-5409
Practice Address - Country:US
Practice Address - Phone:919-552-6113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC076433163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse