Individual
IRENE BONITA GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
3302 GALLOWS RD, FALLS CHURCH, VA 22042-3353
(571) 269-5806
Mailing address
9411 LEE HWY APT 813, FAIRFAX, VA 22031-1800
(571) 269-5806
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
0024177399
VA
Other
Enumeration date
08/14/2019
Last updated
08/14/2019
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