MEDICARE: ROSA GREEN DAVIS NBC-HWC

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	171400000X	Health & Wellness Coach	A-4209682	NC

General Provider Information

NPI Number	:	1790640050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSA GREEN DAVIS NBC-HWC

Provider Business Mailing Address
First Line	:	625 MARION DR
Second Line	:
City	:	MATTHEWS
State	:	NC
Zip	:	28105-2639
Country	:	US
Telephone Number	:	336-829-6760
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 MARION DR
Second Line	:
City	:	MATTHEWS
State	:	NC
Zip	:	28105-2639
Country	:	US
Telephone Number	:	336-829-6760
Fax Number	:

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

Provider Enumeration Date	:	12/18/2025
Last Update Date	:	12/18/2025

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Directions to “ ROSA GREEN DAVIS NBC-HWC” Practice Location

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