Provider Demographics
NPI:1114323078
Name:GREEN, MITSUZI
Entity type:Individual
Prefix:
First Name:MITSUZI
Middle Name:
Last Name:GREEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12110 CITY TREK LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-5093
Mailing Address - Country:US
Mailing Address - Phone:646-508-3595
Mailing Address - Fax:
Practice Address - Street 1:12110 CITY TREK LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-5093
Practice Address - Country:US
Practice Address - Phone:646-508-3595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY667089-1163W00000X
TX374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No163W00000XNursing Service ProvidersRegistered Nurse