Healthcare Provider Details

I. General information

NPI: 1053138909
Provider Name (Legal Business Name): LYNETTE LEIGH GREATHOUSE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNETTE LEIGH GREATHOUSE DEARMAN RN

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 S GLENBURNIE RD STE 2
NEW BERN NC
28562-2610
US

IV. Provider business mailing address

103 BETT DR
GOLDSBORO NC
27534-9569
US

V. Phone/Fax

Practice location:
  • Phone: 919-222-7717
  • Fax:
Mailing address:
  • Phone: 919-222-7717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number263614
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5022908
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: