Individual
MISS NICOLE A GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3800 ST MARY DR, SUITE 103, VALPARAISO, IN 46383-7502
(219) 464-2123
(219) 465-0032
Mailing address
3800 ST MARY DR, SUITE 103, VALPARAISO, IN 46383-7502
(219) 464-2123
(219) 465-0032
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28171988A
IN
363LF0000X
Family Nurse Practitioner
Primary
71004197A
IN
Other
Enumeration date
10/02/2012
Last updated
01/31/2013
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