=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063826303
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEREDITH ANN MACKENZIE-GREENLE PHD, RN, ANP-BC, CNE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2014
-----------------------------------------------------
Last Update Date | 12/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 185 W ESSEX AVE
-----------------------------------------------------
City | LANSDOWNE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19050-1506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-282-6296
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 185 W ESSEX AVE
-----------------------------------------------------
City | LANSDOWNE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19050-1506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-282-6296
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN585565
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | SP013982
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------