Provider Demographics
NPI:1295004653
Name:GREEN, MELISSA (RN)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 ROUTE 245
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14561-9733
Mailing Address - Country:US
Mailing Address - Phone:585-526-6251
Mailing Address - Fax:585-526-4435
Practice Address - Street 1:2705 ROUTE 245
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:NY
Practice Address - Zip Code:14561-9733
Practice Address - Country:US
Practice Address - Phone:585-526-6251
Practice Address - Fax:585-526-4435
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY486096-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse