Healthcare Provider Details

I. General information

NPI: 1235355892
Provider Name (Legal Business Name): RANDY GREENBERG APRN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 05/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1087 E MONTAGUE AVE
NORTH CHARLESTON SC
29405-4826
US

IV. Provider business mailing address

1087 E MONTAGUE AVE
NORTH CHARLESTON SC
29405-4826
US

V. Phone/Fax

Practice location:
  • Phone: 843-745-7140
  • Fax:
Mailing address:
  • Phone: 843-745-7140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number3030
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number3030
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: