Healthcare Provider Details

I. General information

NPI: 1891754974
Provider Name (Legal Business Name): EVERGREEN WOMENS HEALTH CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2006
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 MAIN ST SUITE 131
NASHUA NH
03060-2919
US

IV. Provider business mailing address

280 MAIN ST SUITE 131
NASHUA NH
03060-2919
US

V. Phone/Fax

Practice location:
  • Phone: 603-882-0555
  • Fax: 603-882-0360
Mailing address:
  • Phone: 603-882-0555
  • Fax: 603-882-0360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALAN J GREEN
Title or Position: OWNER
Credential: M.D.
Phone: 603-882-0555