MEDICARE: NANEKE T GREEN

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1134086838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANEKE T GREEN

Provider Business Mailing Address
First Line	:	1413 REDWOOD LN
Second Line	:
City	:	WYNCOTE
State	:	PA
Zip	:	19095-1905
Country	:	US
Telephone Number	:	215-768-7619
Fax Number	:

Provider Business Practice Location Address
First Line	:	1413 REDWOOD LN
Second Line	:
City	:	WYNCOTE
State	:	PA
Zip	:	19095-1905
Country	:	US
Telephone Number	:	215-768-7619
Fax Number	:

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

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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Directions to “ NANEKE T GREEN ” Practice Location

Language	Start Address	Practice Location

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