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NPI Code Detail

MEDICARE: CAROLYN RUTH GREEN APNP

MEDICARE: CAROLYN RUTH GREEN APNP
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
1363LF0000XFamily Nurse Practitioner1272WI

General Provider Information

NPI Number : 1699987578
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN RUTH GREEN APNP
Provider Business Mailing Address
First Line : 2549 VAN HISE AVE
Second Line :
City : MADISON
State : WI
Zip : 53705-3849
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2917 INTERNATIONAL LN
Second Line :
City : MADISON
State : WI
Zip : 53704-3135
Country : US
Telephone Number : 608-245-3416
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2007
Last Update Date : 07/08/2007

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