Healthcare Provider Details

I. General information

NPI: 1295304301
Provider Name (Legal Business Name): TEVA MELVIN GREENWOOD CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 06/23/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 LIBERTY HILL RD
LUMBERTON NC
28358-2446
US

IV. Provider business mailing address

400 LIBERTY HILL RD
LUMBERTON NC
28358-2446
US

V. Phone/Fax

Practice location:
  • Phone: 910-738-8060
  • Fax:
Mailing address:
  • Phone: 910-739-3318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberMELV-A6W7R
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: