MEDICARE: SHEENA GREEN-MCCREE

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4704374814	MI
2	363L00000X	Nurse Practitioner	4704374814	MI
3	163W00000X	Registered Nurse	4704374814	MI

General Provider Information

NPI Number	:	1790659605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEENA GREEN-MCCREE

Provider Business Mailing Address
First Line	:	43996 WOODWARD AVE STE 5
Second Line	:	#1049
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-5049
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	43996 WOODWARD AVE STE 5
Second Line	:	#1049
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-5049
Country	:	US
Telephone Number	:	248-509-4716
Fax Number	:

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

Provider Enumeration Date	:	10/02/2025
Last Update Date	:	10/02/2025

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