Healthcare Provider Details

I. General information

NPI: 1083630115
Provider Name (Legal Business Name): TERRY L GREEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 N.E. 13TH STREET SUITE 3000
OKLAHOMA CITY OK
73104-5099
US

IV. Provider business mailing address

4900 S. MONACO ST SUITE 210
DENVER CO
80237-3486
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-7498
  • Fax: 405-271-4328
Mailing address:
  • Phone: 405-271-7498
  • Fax: 405-271-4328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number65023
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: