Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | C10008651 | DE |
N | 208000000X | Pediatrician | C10008651 | DE |
N | 208000000X | Pediatrician | C7-0003278 | DE |
Y | 208D00000X | General Practice Physician | C10008651 | DE |
NPI | 1578695045 |
---|---|
Provider Name | Nicole A Green |
First Address | Rockland, DE 19723-0191 |
Second Address | Wilmington, DE 19803-3607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2007 |
Last Update Date | 10/12/2008 |