Provider Demographics
NPI:1679039515
Name:GREEN, DEBORAH (LPN)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ROBERTS RD STE 103
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-6631
Mailing Address - Country:US
Mailing Address - Phone:828-505-3086
Mailing Address - Fax:828-274-6377
Practice Address - Street 1:6 ROBERTS RD STE 103
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-6631
Practice Address - Country:US
Practice Address - Phone:828-505-3086
Practice Address - Fax:828-274-6377
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC049125164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse