Provider Demographics
NPI:1336920636
Name:GREENWALT, LILA BROOKE (RN)
Entity Type:Individual
Prefix:MRS
First Name:LILA
Middle Name:BROOKE
Last Name:GREENWALT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 PRELUDE DR
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:NC
Mailing Address - Zip Code:28574-8477
Mailing Address - Country:US
Mailing Address - Phone:256-473-1786
Mailing Address - Fax:
Practice Address - Street 1:3205 RANDALL PKWY STE 204
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2569
Practice Address - Country:US
Practice Address - Phone:910-790-0109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-181764163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse