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General NPI Number Information
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NPI Number | 1205489754
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Entity Type | Individual
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Provider Name | JESSICA GREEN MSN, RN-BC, AGCNS-BC
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Gender | Female
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Dates
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Enumeration Date | 07/23/2019
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Last Update Date | 07/23/2019
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Provider Practice Location Address
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Address Line | 11700 N MERIDIAN ST
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City | CARMEL
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State | IN
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Zip | 46032-4656
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Country | US
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Telephone | 317-688-3409
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Fax |
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Provider Business Mailing Address
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Address Line | 1686 N VISTA DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46280-1799
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Country | US
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Telephone | 812-239-0491
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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 | 364SG0600X
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Taxonomy Name | Gerontology Clinical Nurse Specialist
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License Number | 28172147A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number | 28172147A
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License Number State | IN
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