Healthcare Provider Details

I. General information

NPI: 1124963889
Provider Name (Legal Business Name): ALTOVISE COHEN-GREEN LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 THOMAS COHEN DR
HILTON HEAD ISLAND SC
29926-1413
US

IV. Provider business mailing address

7216 GARRETT CT
CHARLOTTE NC
28214-0076
US

V. Phone/Fax

Practice location:
  • Phone: 980-405-4821
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number54461
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: