Provider Demographics
NPI:1326586454
Name:GREEN, FAITH CHRISTINE (LPN)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:CHRISTINE
Last Name:GREEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 ACADEMY RD NE
Mailing Address - Street 2:APT 1022
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-7378
Mailing Address - Country:US
Mailing Address - Phone:505-262-1538
Mailing Address - Fax:
Practice Address - Street 1:10700 ACADEMY RD NE
Practice Address - Street 2:APT 1022
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-7378
Practice Address - Country:US
Practice Address - Phone:505-262-1538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NML18941164W00000X
NML18942163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Single Specialty
No164W00000XNursing Service ProvidersLicensed Practical Nurse