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NPI Code Detail

MEDICARE: ZACIA GREEN NP

MEDICARE: ZACIA 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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner71012739AIN

General Provider Information

NPI Number : 1659099810
Entity Type Code : Individual
Provider Name (Legal Business Name) : ZACIA GREEN NP
Provider Business Mailing Address
First Line : 2120 CANVASBACK DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46234-8807
Country : US
Telephone Number : 317-332-2918
Fax Number :
Provider Business Practice Location Address
First Line : 1311 W 96TH ST STE 110
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-1172
Country : US
Telephone Number : 317-876-3699
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2022
Last Update Date : 08/15/2022

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Directions to “ ZACIA GREEN NP” Practice Location

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