Healthcare Provider Details

I. General information

NPI: 1154690477
Provider Name (Legal Business Name): JULIE LYNN GREEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 N MERIDIAN ST SUITE 500
INDIANAPOLIS IN
46204-1077
US

IV. Provider business mailing address

950 N MERIDIAN ST SUITE 500
INDIANAPOLIS IN
46204-1077
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-4941
  • Fax: 317-962-4950
Mailing address:
  • Phone: 317-962-4941
  • Fax: 317-962-4950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number71003884A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71003884A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: