Provider Demographics
NPI:1740759406
Name:GREEN, ROBERT LEE JR (RN)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LEE
Last Name:GREEN
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5201 CEDAR MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-4642
Mailing Address - Country:US
Mailing Address - Phone:469-718-7301
Mailing Address - Fax:469-718-7301
Practice Address - Street 1:5201 CEDAR MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-4642
Practice Address - Country:US
Practice Address - Phone:469-718-7301
Practice Address - Fax:469-718-7301
Is Sole Proprietor?:No
Enumeration Date:2018-11-24
Last Update Date:2018-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX742930163W00000X
TX018448163WA2000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator