Provider Demographics
NPI:1114572104
Name:GREEN, HOLLIE (CRNP)
Entity Type:Individual
Prefix:
First Name:HOLLIE
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 ORMAND ST
Mailing Address - Street 2:
Mailing Address - City:FROSTBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21532-1528
Mailing Address - Country:US
Mailing Address - Phone:301-697-8379
Mailing Address - Fax:
Practice Address - Street 1:104 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:GRANTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21536-1086
Practice Address - Country:US
Practice Address - Phone:301-895-5107
Practice Address - Fax:301-533-3299
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR220028363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily