Provider Demographics
NPI:1023144789
Name:GREEN, ROSEMARY ELLEN (WHCNP)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:ELLEN
Last Name:GREEN
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 GOODWILL RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-1412
Mailing Address - Country:US
Mailing Address - Phone:845-457-3446
Mailing Address - Fax:845-294-1180
Practice Address - Street 1:7 COATES DR
Practice Address - Street 2:SUITE 4
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6748
Practice Address - Country:US
Practice Address - Phone:845-294-8831
Practice Address - Fax:845-294-1180
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY420152363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner