Healthcare Provider Details

I. General information

NPI: 1174448757
Provider Name (Legal Business Name): EMMA GREEN LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 MONOCACY TRL
SPRING GROVE PA
17362-1512
US

IV. Provider business mailing address

181 MAYLYN AVE
DALLASTOWN PA
17313-9209
US

V. Phone/Fax

Practice location:
  • Phone: 717-779-7797
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN315462
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: