Healthcare Provider Details

I. General information

NPI: 1922731405
Provider Name (Legal Business Name): EMILY MARIE GREEN RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2022
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9205 BAILEYWICK RD FL 2
RALEIGH NC
27615-1977
US

IV. Provider business mailing address

9205 BAILEYWICK RD FL 2
RALEIGH NC
27615-1977
US

V. Phone/Fax

Practice location:
  • Phone: 860-985-4698
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number355073
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: