MEDICARE: MRS. MARY ONNOLEE GREEN RN

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	163WS0200X	School Registered Nurse	656035	NY

General Provider Information

NPI Number	:	1730794918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY ONNOLEE GREEN RN

Provider Business Mailing Address
First Line	:	435 EAST ST
Second Line	:
City	:	CANANDAIGUA
State	:	NY
Zip	:	14424-1364
Country	:	US
Telephone Number	:	585-396-3820
Fax Number	:	585-396-3957

Provider Business Practice Location Address
First Line	:	435 EAST ST
Second Line	:
City	:	CANANDAIGUA
State	:	NY
Zip	:	14424-1364
Country	:	US
Telephone Number	:	585-396-3820
Fax Number	:	585-396-3957

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

Provider Enumeration Date	:	09/14/2020
Last Update Date	:	09/14/2020

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