MEDICARE: ERIN MCGRAW GREEN FNP-BC

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	363LF0000X	Family Nurse Practitioner	R879425	MS
2	363LF0000X	Family Nurse Practitioner	21146	TN

General Provider Information

NPI Number	:	1730439407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN MCGRAW GREEN FNP-BC

Provider Business Mailing Address
First Line	:	1771 CURTIS DR
Second Line	:
City	:	IUKA
State	:	MS
Zip	:	38852-1001
Country	:	US
Telephone Number	:	662-423-6014
Fax Number	:	662-423-2972

Provider Business Practice Location Address
First Line	:	1771 CURTIS DR
Second Line	:
City	:	IUKA
State	:	MS
Zip	:	38852-1001
Country	:	US
Telephone Number	:	662-423-6014
Fax Number	:	662-423-2972

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

Provider Enumeration Date	:	09/10/2012
Last Update Date	:	03/29/2021

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Directions to “ ERIN MCGRAW GREEN FNP-BC” Practice Location

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