Provider Demographics
NPI:1538212378
Name:PEREZ-GREENE, IRIS IVETTE (NP)
Entity type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:IVETTE
Last Name:PEREZ-GREENE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:IRIS
Other - Middle Name:IVETTE
Other - Last Name:PEREZE-NOIDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:106 IRVING ST NW
Mailing Address - Street 2:SUITE 2700N
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2927
Mailing Address - Country:US
Mailing Address - Phone:202-723-5524
Mailing Address - Fax:202-291-0512
Practice Address - Street 1:18109 PRINCE PHILIP DR
Practice Address - Street 2:SUITE 225
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1519
Practice Address - Country:US
Practice Address - Phone:301-774-5810
Practice Address - Fax:301-774-0188
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR093718363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCD0361OtherRAILROAD MEDICARE GROUP
MD066MOtherMEDICARE GROUP
DC409629OtherMEDICARE GROUP
MD066MQ065OtherINDIV MEDICARE