MEDICARE: MS. REBECCA LYN GREEN N.P.

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN095478	AZ

General Provider Information

NPI Number	:	1982714416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REBECCA LYN GREEN N.P.

Provider Business Mailing Address
First Line	:	4747 N 7TH ST
Second Line	:	SUITE 100
City	:	PHOENIX
State	:	AZ
Zip	:	85014-3653
Country	:	US
Telephone Number	:	602-279-7655
Fax Number	:	602-264-1806

Provider Business Practice Location Address
First Line	:	1255 W BASELINE RD
Second Line	:	SUITE B258
City	:	MESA
State	:	AZ
Zip	:	85202-5820
Country	:	US
Telephone Number	:	480-820-0825
Fax Number	:	480-820-7863

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	12/18/2012

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