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General NPI Number Information
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NPI Number | 1144792474
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Entity Type | Individual
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Provider Name | PATRICIA ADRIANNE GREEN DNP
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Gender | Female
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Dates
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Enumeration Date | 12/27/2018
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Last Update Date | 06/01/2023
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Provider Practice Location Address
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Address Line | 395 W COUGAR BLVD STE 102
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City | PROVO
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State | UT
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Zip | 84604-3334
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Country | US
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Telephone | 801-357-8586
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Fax | 801-357-8586
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Provider Business Mailing Address
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Address Line | PO BOX 27128
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City | SALT LAKE CITY
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State | UT
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Zip | 84127-0128
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Country | US
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Telephone |
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Fax |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 103806472205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 24957.1819
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License Number State | WY
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 10380647-4405
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License Number State | UT
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