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General NPI Number Information
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NPI Number | 1144415050
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Entity Type | Individual
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Provider Name | MASHENDA GREEN APRN
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Gender | Female
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 11/11/2010
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Provider Practice Location Address
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Address Line | 90 RALPH ST APT 3
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City | BELLEVILLE
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State | NJ
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Zip | 07109-5204
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Country | US
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Telephone | 973-302-4949
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Fax |
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Provider Business Mailing Address
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Address Line | 90 RALPH STREET UNIT # 3
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City | BELLEVILLE
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State | NJ
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Zip | 07109
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Country | US
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Telephone | 973-302-4949
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 26NJ00141100
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License Number State | NJ
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