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General NPI Number Information
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NPI Number | 1194371211
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Entity Type | Individual
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Provider Name | IRENE BONITA GREEN NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 08/14/2019
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Last Update Date | 08/14/2019
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Provider Practice Location Address
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Address Line | 3302 GALLOWS RD
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City | FALLS CHURCH
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State | VA
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Zip | 22042-3353
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Country | US
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Telephone | 571-269-5806
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Fax |
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Provider Business Mailing Address
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Address Line | 9411 LEE HWY APT 813
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City | FAIRFAX
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State | VA
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Zip | 22031-1800
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Country | US
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Telephone | 571-269-5806
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 0024177399
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License Number State | VA
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