Healthcare Provider Details

I. General information

NPI: 1164649968
Provider Name (Legal Business Name): RUIE TYLER GREEN RNC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 CUMBERLAND BND
NASHVILLE TN
37228-1803
US

IV. Provider business mailing address

275 CUMBERLAND BND
NASHVILLE TN
37228-1803
US

V. Phone/Fax

Practice location:
  • Phone: 615-446-3061
  • Fax: 615-446-9567
Mailing address:
  • Phone: 615-446-3061
  • Fax: 615-446-9567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN0000100328
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: