MEDICARE: TAMMY LYNN GREEN APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN002197	NV

General Provider Information

NPI Number	:	1013361435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY LYNN GREEN APRN

Provider Business Mailing Address
First Line	:	3640 WEDO WAY
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-2281
Country	:	US
Telephone Number	:	702-235-3488
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 N TENAYA WAY
Second Line	:	SUITE 210
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1420
Country	:	US
Telephone Number	:	702-255-0500
Fax Number	:	702-821-1704

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2016
Last Update Date	:	04/29/2016

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