Provider Demographics
NPI:1669038741
Name:GREEN, HOLLIE A (AGAC-NP-BC)
Entity type:Individual
Prefix:MRS
First Name:HOLLIE
Middle Name:A
Last Name:GREEN
Suffix:
Gender:F
Credentials:AGAC-NP-BC
Other - Prefix:MRS
Other - First Name:HOLLIE
Other - Middle Name:ANN
Other - Last Name:RACELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, AGACNP-BC
Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-5700
Mailing Address - Fax:810-342-5545
Practice Address - Street 1:1000 HARRINGTON ST
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2920
Practice Address - Country:US
Practice Address - Phone:810-241-8857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704229157363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care