Provider Demographics
NPI:1659864502
Name:GREEN, KYECIA CHERRELLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:KYECIA
Middle Name:CHERRELLE
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 1:243 VALLEY BROOK CIR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-3640
Mailing Address - Country:US
Mailing Address - Phone:585-319-7082
Mailing Address - Fax:
Practice Address - Street 1:243 VALLEY BROOK CIR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-3640
Practice Address - Country:US
Practice Address - Phone:585-319-7082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY733756163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine