Healthcare Provider Details

I. General information

NPI: 1134795529
Provider Name (Legal Business Name): EMILY FRANCES GREEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 PIEDMONT AVE STE 7200
CINCINNATI OH
45219-4224
US

IV. Provider business mailing address

3545 VISTA AVE
CINCINNATI OH
45208-1053
US

V. Phone/Fax

Practice location:
  • Phone: 134-758-7875
  • Fax: 513-929-7239
Mailing address:
  • Phone: 217-549-6361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.006715RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: