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NPI Code Detail

MEDICARE: IYANA SARAH - ANTWANETTE GREEN

MEDICARE: IYANA SARAH - ANTWANETTE GREEN
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1285427989
Entity Type Code : Individual
Provider Name (Legal Business Name) : IYANA SARAH - ANTWANETTE GREEN
Provider Business Mailing Address
First Line : 5121 KINGDOM WAY STE 10
Second Line :
City : RALEIGH
State : NC
Zip : 27607-6062
Country : US
Telephone Number : 919-559-1316
Fax Number :
Provider Business Practice Location Address
First Line : 5121 KINGDOM WAY STE 10
Second Line :
City : RALEIGH
State : NC
Zip : 27607-6062
Country : US
Telephone Number : 919-559-1316
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2025
Last Update Date : 05/26/2025

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Directions to “ IYANA SARAH - ANTWANETTE GREEN ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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