Provider Demographics
NPI:1861049033
Name:GREEN, MARY ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9127 RT240
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14171
Mailing Address - Country:US
Mailing Address - Phone:716-942-3884
Mailing Address - Fax:
Practice Address - Street 1:9127 RT240
Practice Address - Street 2:
Practice Address - City:WEST VALLEY
Practice Address - State:NY
Practice Address - Zip Code:14171
Practice Address - Country:US
Practice Address - Phone:716-942-3884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider