Provider Demographics
NPI:1235534033
Name:GREEN, NADINE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:
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 1:14421 PEAR ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-8974
Mailing Address - Country:US
Mailing Address - Phone:909-307-4359
Mailing Address - Fax:
Practice Address - Street 1:14421 PEAR ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-8974
Practice Address - Country:US
Practice Address - Phone:909-307-4359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN122344164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse