Nicole Green, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

631644 Issued in NY

Practice address

17566 Van Allen Rd S
Watertown, NY 13601-9342

Phone

(315) 408-6498

NPI assigned

Dec 2, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1638403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638403200000",
    "number": "1144988601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17566 VAN ALLEN RD S",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136019342",
            "telephone_number": "315-408-6498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17566 VAN ALLEN RD S",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136019342",
            "telephone_number": "315-408-6498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-02",
        "last_updated": "2021-12-02",
        "certification_date": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "631644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Grass
• Daniel Stanley Gray, MD
• Great Beginnings Pediatric Dentistry PLLC
• Charrie Lynn Green
• Jessica Green
• Shellie A Green
• Shannon Pauline Gregory, MS, CCC-SLP
• Olivia Grenier
• Tracey Grey, RN, CNOR,CRNFA
• Alexandra Grieco, PHARM. D.

• Registered Nurse in Watertown, NY
• Providers in Watertown, NY by specialty
• Registered Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.