Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 1031690 | TX |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 259061 | AZ |
NPI | 1336711332 |
---|---|
Provider Name | Noel Iline Green |
First Address | Montgomery, TX 77356-4205 |
Second Address | Phoenix, AZ 85016-7710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2021 |
Last Update Date | 11/07/2021 |