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General NPI Number Information
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NPI Number | 1760275804
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Entity Type | Individual
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Provider Name | MYIESHA NACOLE MINGO-GREEN
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Gender | Female
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Dates
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Enumeration Date | 05/22/2025
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 3002 QUAIL RUN DR
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City | HUMBLE
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State | TX
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Zip | 77396-1856
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Country | US
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Telephone | 281-846-9860
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Fax |
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Provider Business Mailing Address
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Address Line | 3002 QUAIL RUN DR
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City | HUMBLE
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State | TX
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Zip | 77396-1856
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Country | US
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Telephone | 281-846-9860
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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 | 2083C0008X
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Taxonomy Name | Clinical Informatics Physician
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License Number | 00000000
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License Number State | TX
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