Provider Demographics
NPI:1518250158
Name:GREEN, ALICIA ADELE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:ALICIA
Middle Name:ADELE
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 1:127 N COLUMBUS AVE
Mailing Address - Street 2:PH
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-1129
Mailing Address - Country:US
Mailing Address - Phone:914-371-7058
Mailing Address - Fax:
Practice Address - Street 1:127 N COLUMBUS AVE
Practice Address - Street 2:PH
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1129
Practice Address - Country:US
Practice Address - Phone:914-371-7058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305271-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse