Provider Demographics
NPI:1548778137
Name:GREENE, MEGUAYEN ELIZABETH
Entity Type:Individual
Prefix:
First Name:MEGUAYEN
Middle Name:ELIZABETH
Last Name:GREENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TICINO CT
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-8989
Mailing Address - Country:US
Mailing Address - Phone:704-780-0481
Mailing Address - Fax:
Practice Address - Street 1:30522 GARNAND DR. MARTIN-BROOK STUDENT CENTER
Practice Address - Street 2:
Practice Address - City:EMORY
Practice Address - State:VA
Practice Address - Zip Code:24327-2432
Practice Address - Country:US
Practice Address - Phone:276-944-4121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer