Provider Demographics
NPI:1851288104
Name:MCGOWAN-GREEN, KADIJAH L (LPN)
Entity type:Individual
Prefix:
First Name:KADIJAH
Middle Name:L
Last Name:MCGOWAN-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 1:434 WESTFIELD ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-2138
Mailing Address - Country:US
Mailing Address - Phone:585-353-1977
Mailing Address - Fax:
Practice Address - Street 1:434 WESTFIELD ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14619-2138
Practice Address - Country:US
Practice Address - Phone:585-353-1977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY341496164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse