Individual
NICOLE MARIE GREENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
12921 S VISTA STATION BLVD, DRAPER, UT 84020-2376
(435) 354-9746
Mailing address
458 W BLAZER LN, STANSBURY PARK, UT 84074-1290
(435) 840-8918
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
8483463-4405
UT
363LG0600X
Gerontology Nurse Practitioner
Primary
8483463-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8483463-4405
APRN LICENSE
UT
Enumeration date
09/24/2021
Last updated
08/12/2024
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