MEDICARE: LINDA ANN GREEN NP

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	163W00000X	Registered Nurse	28150843A	IN
2	363LA2100X	Acute Care Nurse Practitioner	0000	IN
3	363L00000X	Nurse Practitioner	71007113A	IN

General Provider Information

NPI Number	:	1467986844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA ANN GREEN NP

Provider Business Mailing Address
First Line	:	4015 GATEWAY BLVD STE 2120
Second Line	:
City	:	NEWBURGH
State	:	IN
Zip	:	47630-9460
Country	:	US
Telephone Number	:	812-842-0907
Fax Number	:	812-464-4485

Provider Business Practice Location Address
First Line	:	4015 GATEWAY BLVD STE 2120
Second Line	:
City	:	NEWBURGH
State	:	IN
Zip	:	47630-9460
Country	:	US
Telephone Number	:	812-842-0907
Fax Number	:	812-490-7015

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

Provider Enumeration Date	:	04/12/2017
Last Update Date	:	06/15/2017

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