MEDICARE: EMILY NICOLE GREEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	043.129288	IL

General Provider Information

NPI Number	:	1386507911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY NICOLE GREEN

Provider Business Mailing Address
First Line	:	2901 E LINCOLNWAY
Second Line	:
City	:	STERLING
State	:	IL
Zip	:	61081-1780
Country	:	US
Telephone Number	:	815-632-6200
Fax Number	:	815-632-6201

Provider Business Practice Location Address
First Line	:	2901 E LINCOLNWAY
Second Line	:
City	:	STERLING
State	:	IL
Zip	:	61081-1780
Country	:	US
Telephone Number	:	815-632-6200
Fax Number	:	815-632-6201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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Directions to “ EMILY NICOLE GREEN ” Practice Location

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