Individual
HEATHER L GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
739 IRVING AVE STE 450, SYRACUSE, NY 13210-1663
(315) 470-7364
(315) 766-1103
Mailing address
1001 W FAYETTE ST STE 400, SYRACUSE, NY 13204-2866
(315) 937-3433
(315) 787-5060
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
591667
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
F305686
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03357426
—
NY
Enumeration date
04/27/2011
Last updated
04/22/2026
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