MEDICARE: ASHLEE LYN GREEN LPN

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	272730	NY

General Provider Information

NPI Number	:	1518198605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEE LYN GREEN LPN

Provider Business Mailing Address
First Line	:	PO BOX 122
Second Line	:
City	:	WHITE SULPHUR SPRINGS
State	:	NY
Zip	:	12787-0122
Country	:	US
Telephone Number	:	845-292-3432
Fax Number	:

Provider Business Practice Location Address
First Line	:	72 MIDWAY RD
Second Line	:
City	:	LIVINGSTON MANOR
State	:	NY
Zip	:	12758
Country	:	US
Telephone Number	:	845-292-3432
Fax Number	:

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

Provider Enumeration Date	:	08/06/2009
Last Update Date	:	08/06/2009

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