Healthcare Provider Details

I. General information

NPI: 1528175049
Provider Name (Legal Business Name): AMY JO GREEN RN, MSN, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY JO KRIDER RN, MSN, CRNP

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BRINTON RD
PITTSBURGH PA
15221-4533
US

IV. Provider business mailing address

2340 BETHEL CHURCH RD
BETHEL PARK PA
15102-2978
US

V. Phone/Fax

Practice location:
  • Phone: 412-977-2431
  • Fax: 888-816-8109
Mailing address:
  • Phone:
  • Fax: 412-831-2407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTP006399B
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberTP006399B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: