MEDICARE: GREGORY ADRIAN GREENBERG AGCNS-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364S00000X	Clinical Nurse Specialist	AP142303	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP142303	OTHER	TX	TEXAS STATE BOARD OF NURSING

General Provider Information

NPI Number	:	1083267702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY ADRIAN GREENBERG AGCNS-BC

Provider Business Mailing Address
First Line	:	1408 COLETO ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78702
Country	:	US
Telephone Number	:	610-716-9159
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 W 38TH ST STE 403
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78705-1013
Country	:	US
Telephone Number	:	512-593-7902
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2019
Last Update Date	:	07/22/2019

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