Provider Demographics
NPI:1053138909
Name:GREATHOUSE, LYNETTE LEIGH (RN)
Entity type:Individual
Prefix:MS
First Name:LYNETTE
Middle Name:LEIGH
Last Name:GREATHOUSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:LYNETTE
Other - Middle Name:LEIGH
Other - Last Name:GREATHOUSE DEARMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:103 BETT DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9569
Mailing Address - Country:US
Mailing Address - Phone:919-222-7717
Mailing Address - Fax:
Practice Address - Street 1:1401 W ASH ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-1078
Practice Address - Country:US
Practice Address - Phone:919-947-7314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC263614163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health