Provider Demographics
NPI:1861005803
Name:GREENBERG, ELENA LOREDANA
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:LOREDANA
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:LOREDANA
Other - Last Name:CACAREAZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:334 BRENTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-4261
Mailing Address - Country:US
Mailing Address - Phone:915-494-9101
Mailing Address - Fax:
Practice Address - Street 1:334 BRENTFORD AVE
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-4261
Practice Address - Country:US
Practice Address - Phone:915-494-9101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC291602163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse