Healthcare Provider Details

I. General information

NPI: 1538212378
Provider Name (Legal Business Name): IRIS IVETTE PEREZ-GREENE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IRIS IVETTE PEREZE-NOIDEN NP

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18109 PRINCE PHILIP DR SUITE 225
OLNEY MD
20832-1519
US

IV. Provider business mailing address

106 IRVING ST NW SUITE 2700N
WASHINGTON DC
20010-2927
US

V. Phone/Fax

Practice location:
  • Phone: 301-774-5810
  • Fax: 301-774-0188
Mailing address:
  • Phone: 202-723-5524
  • Fax: 202-291-0512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR093718
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: