Provider Demographics
NPI:1528181385
Name:GREEN, PATRICIA (MSN, RN, FNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:MSN, RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 INTERSTATE 45 N
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-4901
Mailing Address - Country:US
Mailing Address - Phone:936-522-4961
Mailing Address - Fax:936-522-4964
Practice Address - Street 1:4015 INTERSTATE 45 N
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-4901
Practice Address - Country:US
Practice Address - Phone:936-522-4961
Practice Address - Fax:936-522-4964
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX617443363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00J21AOtherMEDICARE GROUP
TX094010801OtherMEDICAID GROUP