MEDICARE: TERRY L GREEN NP

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	363LA2200X	Adult Health Nurse Practitioner	65023	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083630115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY L GREEN NP

Provider Business Mailing Address
First Line	:	4900 S. MONACO ST
Second Line	:	SUITE 210
City	:	DENVER
State	:	CO
Zip	:	80237-3486
Country	:	US
Telephone Number	:	405-271-7498
Fax Number	:	405-271-4328

Provider Business Practice Location Address
First Line	:	940 N.E. 13TH STREET
Second Line	:	SUITE 3000
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-5099
Country	:	US
Telephone Number	:	405-271-7498
Fax Number	:	405-271-4328

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	09/16/2013

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