MEDICARE: NICOLE GREENE

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	163WH0200X	Home Health Registered Nurse	854263	TX

General Provider Information

NPI Number	:	1689154916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE GREENE

Provider Business Mailing Address
First Line	:	3043 CIMARRON PASS DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-8647
Country	:	US
Telephone Number	:	838-215-1937
Fax Number	:

Provider Business Practice Location Address
First Line	:	3043 CIMARRON PASS DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-8647
Country	:	US
Telephone Number	:	183-221-5193
Fax Number	:

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

Provider Enumeration Date	:	08/16/2018
Last Update Date	:	08/16/2018

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Directions to “ NICOLE GREENE ” Practice Location

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