Healthcare Provider Details

I. General information

NPI: 1053715599
Provider Name (Legal Business Name): LEAH GREER PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2014
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 S 17TH ST
WILMINGTON NC
28401-7407
US

IV. Provider business mailing address

PO BOX 602484
CHARLOTTE NC
28260-2484
US

V. Phone/Fax

Practice location:
  • Phone: 910-815-5830
  • Fax: 910-815-5698
Mailing address:
  • Phone: 910-815-5830
  • Fax: 910-815-5698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5007193
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number189070
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number189070
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: