MEDICARE: MITSUZI GREEN

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	163W00000X	Registered Nurse	667089-1	NY
2	374J00000X	Doula		TX

General Provider Information

NPI Number	:	1114323078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITSUZI GREEN

Provider Business Mailing Address
First Line	:	12110 CITY TREK LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-5093
Country	:	US
Telephone Number	:	646-508-3595
Fax Number	:

Provider Business Practice Location Address
First Line	:	12110 CITY TREK LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-5093
Country	:	US
Telephone Number	:	646-508-3595
Fax Number	:

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

Provider Enumeration Date	:	11/05/2014
Last Update Date	:	03/04/2025

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Directions to “ MITSUZI GREEN ” Practice Location

Language	Start Address	Practice Location

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