Healthcare Provider Details

I. General information

NPI: 1972045540
Provider Name (Legal Business Name): ALVIN GREEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 MCHINES PL SUITE 120
RALEIGH NC
27616-1953
US

IV. Provider business mailing address

5800 MCHINES PL SUITE 120
RALEIGH NC
27616-1953
US

V. Phone/Fax

Practice location:
  • Phone: 919-981-0790
  • Fax: 919-981-0135
Mailing address:
  • Phone: 919-981-0790
  • Fax: 919-981-0135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number210114
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: