Provider Demographics
NPI:1235140609
Name:GREENE, ANGELA MARIA (RN, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIA
Last Name:GREENE
Suffix:
Gender:F
Credentials:RN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 S MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-2816
Mailing Address - Country:US
Mailing Address - Phone:770-207-4125
Mailing Address - Fax:770-207-4129
Practice Address - Street 1:1404 S MADISON AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2816
Practice Address - Country:US
Practice Address - Phone:770-207-4125
Practice Address - Fax:770-207-4129
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN080567363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000772835LMedicaid
S62968Medicare UPIN
GA50BBJLFMedicare ID - Type Unspecified