Healthcare Provider Details

I. General information

NPI: 1679730576
Provider Name (Legal Business Name): JODI GREEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CROSSROADS PL
HIGH RIDGE MO
63049-2234
US

IV. Provider business mailing address

161 WASHINGTON ST EIGHT TOWER BRIDGE, SUITE 1400
CONSHOHOCKEN PA
19428-2083
US

V. Phone/Fax

Practice location:
  • Phone: 866-825-3227
  • Fax: 484-450-2617
Mailing address:
  • Phone: 866-825-3227
  • Fax: 484-450-2617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number152741
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: