MEDICARE: NICOLE D GREEN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F0611104	LA

General Provider Information

NPI Number	:	1104105352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE D GREEN NP

Provider Business Mailing Address
First Line	:	1514 JEFFERSON HWY
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70121-2429
Country	:	US
Telephone Number	:	504-842-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	13100 RIVER RD
Second Line	:
City	:	DESTREHAN
State	:	LA
Zip	:	70047-5219
Country	:	US
Telephone Number	:	985-764-7669
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2011
Last Update Date	:	11/25/2024

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