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General NPI Number Information
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NPI Number | 1790906840
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Entity Type | Individual
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Provider Name | SUSAN ROBIN GREEN MSN, CRNP
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Gender | Female
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 131 E CHELTEN AVE PHILADELPHIA PUBLIC HEALTH DEPT HEALTH CARE CENTER #9
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City | PHILADELPHIA
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State | PA
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Zip | 19144
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Country | US
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Telephone | 215-685-5701
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Fax | 215-685-5257
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Provider Business Mailing Address
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Address Line | 8201 HENRY AVE C15
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City | PHILADELPHIA
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State | PA
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Zip | 19128
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Country | US
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Telephone | 215-487-1017
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | RN266978L
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License Number State | PA
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