Provider Demographics
NPI:1295854065
Name:GREEN, CYNTHIA (RN)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:CINDY
Other - Middle Name:
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:871 S. PLANK RD.
Mailing Address - Street 2:PO BOX 197
Mailing Address - City:MT. TREMPER
Mailing Address - State:NY
Mailing Address - Zip Code:12457-0197
Mailing Address - Country:US
Mailing Address - Phone:845-688-2591
Mailing Address - Fax:845-688-7995
Practice Address - Street 1:4789 S DAHLIA ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80121-2013
Practice Address - Country:US
Practice Address - Phone:303-843-9623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO61105163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant