Healthcare Provider Details

I. General information

NPI: 1427338417
Provider Name (Legal Business Name): JENNA L. GREEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 OLIVE WAY STE 200&900
SEATTLE WA
98101-1720
US

IV. Provider business mailing address

608 LINCOLN AVE APT #308
SAINT PAUL MN
55102-2877
US

V. Phone/Fax

Practice location:
  • Phone: 206-329-1760
  • Fax:
Mailing address:
  • Phone: 651-492-8588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60759481
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR184970-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: