MEDICARE: LISA MARIE GREENE

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	363LF0000X	Family Nurse Practitioner	27177	TN

General Provider Information

NPI Number	:	1134750466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARIE GREENE

Provider Business Mailing Address
First Line	:	1065 HERSHEY DR
Second Line	:
City	:	WHITESBURG
State	:	TN
Zip	:	37891-9255
Country	:	US
Telephone Number	:	423-231-8878
Fax Number	:

Provider Business Practice Location Address
First Line	:	1065 HERSHEY DR
Second Line	:
City	:	WHITESBURG
State	:	TN
Zip	:	37891-9255
Country	:	US
Telephone Number	:	423-231-8878
Fax Number	:

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

Provider Enumeration Date	:	01/27/2020
Last Update Date	:	03/02/2020

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Directions to “ LISA MARIE GREENE ” Practice Location

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