| Doctor Name: | DR. NICOLE RENEE GREEN |
| NPI Number: | 1083002430 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DVM |
| License Number: | 6612 |
| Business Practice Address: | 14370 Parallel Rd Basehor, KS - 660073004 |
| Business Phone Number: | 9137241919 |
| Business Fax Number: | 9137242013 |
| Mailing Address: | 14370 Parallel Rd, BASEHOR |
| State: | KS |
| Postal Code: | 660073004 |
| Phone Number: | 9137241919 |
| Fax Number: | 9137242013 |
| NPI Enumeration Date: | 01/07/2015 |
| NPI Last Update Date: | 01/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174M00000X |
| License Number: | 6612 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Veterinarian |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A doctor of veterinary medicine, trained and authorized to practice veterinarian medicine and surgery. |