Provider Demographics
NPI:1427611979
Name:GREEN, ROBIN RENEE
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:RENEE
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 1:13700 W RIM DR APT 1202
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-7421
Mailing Address - Country:US
Mailing Address - Phone:682-498-3779
Mailing Address - Fax:
Practice Address - Street 1:13700 W RIM DR APT 1202
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-7421
Practice Address - Country:US
Practice Address - Phone:682-498-3779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX10631816251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health