Provider Demographics
NPI:1669455432
Name:GREEN, NICOLE AMBER (RN)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:AMBER
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:HHC 121 GENERAL HOSPITAL
Mailing Address - Street 2:BOX 227
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96205
Mailing Address - Country:US
Mailing Address - Phone:737-5575
Mailing Address - Fax:
Practice Address - Street 1:HHC 121 GENERAL HOSPITAL
Practice Address - Street 2:BOX 227
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96205
Practice Address - Country:US
Practice Address - Phone:737-5575
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1105027163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical