Provider Demographics
NPI:1235355892
Name:GREENBERG, RANDY (APRN, CNM)
Entity Type:Individual
Prefix:MS
First Name:RANDY
Middle Name:
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1087 E MONTAGUE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-4826
Mailing Address - Country:US
Mailing Address - Phone:843-745-7140
Mailing Address - Fax:
Practice Address - Street 1:1087 E MONTAGUE AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-4826
Practice Address - Country:US
Practice Address - Phone:843-745-7140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3030367A00000X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife