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General NPI Number Information
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NPI Number | 1669314340
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Entity Type | Individual
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Provider Name | DESTINY C GREEN RN
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Gender | Female
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Dates
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Enumeration Date | 04/09/2026
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Last Update Date | 04/09/2026
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Provider Practice Location Address
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Address Line | 6100 N 42ND ST # 108
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City | MILWAUKEE
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State | WI
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Zip | 53209-3560
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Country | US
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Telephone | 414-795-9761
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Fax |
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Provider Business Mailing Address
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Address Line | 6100 N 42ND ST # 108
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City | MILWAUKEE
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State | WI
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Zip | 53209-3560
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Country | US
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Telephone | 414-795-9761
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1108493-30
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State | WI
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Taxonomy #5
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | WI
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