Provider Demographics
NPI:1881617108
Name:GREENE, ELISSA J (NP)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:J
Last Name:GREENE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-8149
Mailing Address - Country:US
Mailing Address - Phone:912-231-1971
Mailing Address - Fax:912-232-7423
Practice Address - Street 1:525 E 34TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-8149
Practice Address - Country:US
Practice Address - Phone:912-231-1971
Practice Address - Fax:912-232-7423
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN100349363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBCCPMedicare ID - Type UnspecifiedNP