Most Relevant Information
Provider Data
| NPI Number: | 1003450388 |
| Provider Name: | MARY ELIZABETH GREEN LPN |
| Entity Type: | Individual |
| Taxonomy Code: | 164W00000X |
| Specialty: | Licensed Practical Nurse |
| License Number: | 76633 |
Most Important Dates
| Enumeration Date: | 10/30/2019 |
| Last Updated: | 10/30/2019 |
Provider Practice Location
650 HIGHLAND AVE # 100
WINSTON SALEM
NC
271014304
Practice Location Phone/Fax
| Phone: | 3366078523 |
| Fax: | 3367730914 |
Provider Mailing Location
284 EXECUTIVE PARK DR STE 100
CONCORD
NC
280251833
Provider Mailing Phone/Fax
| Phone: | 7049391100 |
| Fax: | 7049391173 |