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General NPI Number Information
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NPI Number | 1699277533
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Entity Type | Individual
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Provider Name | MELISSA GREEN APRN
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Gender | Female
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Dates
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Enumeration Date | 03/07/2018
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Last Update Date | 03/07/2018
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Provider Practice Location Address
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Address Line | 219 E BROADWAY
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City | LOUISVILLE
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State | KY
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Zip | 40202-2032
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Country | US
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Telephone | 502-587-0394
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Fax |
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Provider Business Mailing Address
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Address Line | 217 VIRGINIA CT
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City | NEW ALBANY
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State | IN
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Zip | 47150-5076
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Country | US
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Telephone | 812-267-3197
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3012041
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License Number State | KY
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