Provider Demographics
NPI:1023384146
Name:GREEN, VERONICA MAY (NURSE)
Entity Type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:MAY
Last Name:GREEN
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11414 238TH ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3928
Mailing Address - Country:US
Mailing Address - Phone:718-353-6464
Mailing Address - Fax:718-460-6427
Practice Address - Street 1:4621 COLDEN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4134
Practice Address - Country:US
Practice Address - Phone:718-353-6464
Practice Address - Fax:718-460-6427
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY475081163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse