Healthcare Provider Details

I. General information

NPI: 1790351427
Provider Name (Legal Business Name): CLAUDETTE A GREEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1914 J N PEASE PL STE 180&182
CHARLOTTE NC
28262-4504
US

IV. Provider business mailing address

1914 J N PEASE PL
CHARLOTTE NC
28262-4504
US

V. Phone/Fax

Practice location:
  • Phone: 704-909-0304
  • Fax: 704-772-1774
Mailing address:
  • Phone: 704-909-0304
  • Fax: 704-772-1774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number221763
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number27807
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: