Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | F350059 | NY |
NPI | 1093869836 |
---|---|
Provider Name | Kathleen Ann Green |
First Address | Bronx, NY 10464-1516 |
Second Address | New York, NY 10021-1850 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 08/07/2007 |