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NPI Code Detail

MEDICARE: AIMEE GREEN

MEDICARE: AIMEE 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
1163W00000XRegistered Nurse4704228622MI

General Provider Information

NPI Number : 1568194819
Entity Type Code : Individual
Provider Name (Legal Business Name) : AIMEE GREEN
Provider Business Mailing Address
First Line : 1229 EDINGTON ST
Second Line :
City : PORTAGE
State : MI
Zip : 49024-2603
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5300 PATTERSON AVE SE STE 125
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49512-9627
Country : US
Telephone Number : 616-222-5601
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2022
Last Update Date : 06/27/2022

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Directions to “ AIMEE GREEN ” Practice Location

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