Provider Demographics
NPI:1649766569
Name:GREEN, NOELLE (NP)
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:110 COLISEUM XING # 5462
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5971
Mailing Address - Country:US
Mailing Address - Phone:757-712-4767
Mailing Address - Fax:844-593-7433
Practice Address - Street 1:1919 COMMERCE DR STE 465
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-4269
Practice Address - Country:US
Practice Address - Phone:757-712-4767
Practice Address - Fax:844-593-7433
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-03
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI0024175905363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty