Healthcare Provider Details

I. General information

NPI: 1134675937
Provider Name (Legal Business Name): SHANNON MARIE GREEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 HICKMAN RD
DES MOINES IA
50314
US

IV. Provider business mailing address

PO BOX 677075
DALLAS TX
75267-7075
US

V. Phone/Fax

Practice location:
  • Phone: 515-282-8270
  • Fax:
Mailing address:
  • Phone: 641-437-3483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA112605
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: