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NPI Code Detail

MEDICARE: NICHOLAS GREEN

MEDICARE: NICHOLAS 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
1363LF0000XFamily Nurse PractitionerAP145426TX

General Provider Information

NPI Number : 1467087288
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS GREEN
Provider Business Mailing Address
First Line : 2005 ROBIN LN
Second Line :
City : MISSION
State : TX
Zip : 78572-0053
Country : US
Telephone Number : 956-467-7426
Fax Number :
Provider Business Practice Location Address
First Line : 214 CHAPARRAL BLVD
Second Line :
City : RIO GRANDE CITY
State : TX
Zip : 78582-4605
Country : US
Telephone Number : 956-317-1339
Fax Number : 956-317-1360
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2020
Last Update Date : 04/01/2020

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Directions to “ NICHOLAS GREEN ” Practice Location

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