Healthcare Provider Details

I. General information

NPI: 1568273597
Provider Name (Legal Business Name): HANNA NOEL GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22706 ASPAN ST STE 501
LAKE FOREST CA
92630-1603
US

IV. Provider business mailing address

22706 ASPAN ST STE 501
LAKE FOREST CA
92630-1603
US

V. Phone/Fax

Practice location:
  • Phone: 949-565-4138
  • Fax:
Mailing address:
  • Phone: 949-565-4138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number37765
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: