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General NPI Number Information
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NPI Number | 1083583405
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Entity Type | Individual
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Provider Name | SHANDA GREEN
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Gender | Female
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Dates
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Enumeration Date | 11/03/2025
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Last Update Date | 06/14/2026
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Provider Practice Location Address
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Address Line | 13901 TECHNOLOGY DR UNIT AB
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City | OKLAHOMA CITY
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State | OK
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Zip | 73134-1052
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Country | US
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Telephone | 405-606-2727
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 571
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City | PIEDMONT
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State | OK
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Zip | 73078-0571
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Country | US
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Telephone | 304-640-2264
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Fax | 304-640-2264
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 228753
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License Number State | OK
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