Provider Demographics
NPI:1003466996
Name:CECILIA GREEN, NP LLC
Entity Type:Organization
Organization Name:CECILIA GREEN, NP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP-C/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:808-450-8688
Mailing Address - Street 1:1650 ALA MOANA BLVD APT 1411
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-1411
Mailing Address - Country:US
Mailing Address - Phone:808-450-8688
Mailing Address - Fax:
Practice Address - Street 1:1090 KEOLU DR STE 107A
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-3871
Practice Address - Country:US
Practice Address - Phone:808-450-8688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service