Healthcare Provider Details

I. General information

NPI: 1649766569
Provider Name (Legal Business Name): NOELLE GREEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 COMMERCE DR STE 465
HAMPTON VA
23666-4269
US

IV. Provider business mailing address

110 COLISEUM XING # 5462
HAMPTON VA
23666-5971
US

V. Phone/Fax

Practice location:
  • Phone: 757-712-4767
  • Fax: 844-593-7433
Mailing address:
  • Phone: 757-712-4767
  • Fax: 844-593-7433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024175905
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: