Provider Demographics
NPI:1730794918
Name:GREEN, MARY ONNOLEE (RN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ONNOLEE
Last Name:GREEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 EAST ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1364
Mailing Address - Country:US
Mailing Address - Phone:585-396-3820
Mailing Address - Fax:585-396-3957
Practice Address - Street 1:435 EAST ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1364
Practice Address - Country:US
Practice Address - Phone:585-396-3820
Practice Address - Fax:585-396-3957
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY656035163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool