Provider Demographics
NPI:1952974032
Name:GREENE, MELISA MICHELE (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:MELISA
Middle Name:MICHELE
Last Name:GREENE
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 LOCKSLEY CIR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-2428
Mailing Address - Country:US
Mailing Address - Phone:304-541-4642
Mailing Address - Fax:
Practice Address - Street 1:511 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-1944
Practice Address - Country:US
Practice Address - Phone:304-340-1555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV46620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily