Provider Demographics
NPI:1033609011
Name:GREEN, VYONCIA MICHELLE (LVN)
Entity Type:Individual
Prefix:
First Name:VYONCIA
Middle Name:MICHELLE
Last Name:GREEN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 GREEN CREST DR APT 628
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-4171
Mailing Address - Country:US
Mailing Address - Phone:832-882-0080
Mailing Address - Fax:
Practice Address - Street 1:3530 GREEN CREST DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-4162
Practice Address - Country:US
Practice Address - Phone:832-882-0080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX317987164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse