Provider Demographics
NPI:1619201282
Name:GREEN, NANCY ELIZABETH (NCMBT #6773)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ELIZABETH
Last Name:GREEN
Suffix:
Gender:F
Credentials:NCMBT #6773
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2223
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-2223
Mailing Address - Country:US
Mailing Address - Phone:828-406-9186
Mailing Address - Fax:
Practice Address - Street 1:225 BIRCH ST
Practice Address - Street 2:1 - 6
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5535
Practice Address - Country:US
Practice Address - Phone:828-964-8691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6773225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist