Healthcare Provider Details

I. General information

NPI: 1609647247
Provider Name (Legal Business Name): ANDREA CORINTHIAN-GREENE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

672 GLOUCESTER RD
SALUDA VA
23149-2591
US

IV. Provider business mailing address

616 SUN CT
NEWPORT NEWS VA
23605-1032
US

V. Phone/Fax

Practice location:
  • Phone: 804-843-9343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number00001145336
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number00001145336
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number00001145336
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number00001145336
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: