MEDICARE: MS. PAULETTE ELAINE COOTE-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
1	163W00000X	Registered Nurse	778133-01	NY

General Provider Information

NPI Number	:	1760005854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAULETTE ELAINE COOTE-GREEN

Provider Business Mailing Address
First Line	:	4223 HILL AVE FL 2
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-2107
Country	:	US
Telephone Number	:	914-563-6017
Fax Number	:

Provider Business Practice Location Address
First Line	:	4223 HILL AVE # 2F
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-2107
Country	:	US
Telephone Number	:	914-563-6017
Fax Number	:

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

Provider Enumeration Date	:	05/22/2020
Last Update Date	:	05/22/2020

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