MEDICARE: EMILY FRANCES GREEN PA-C

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	363A00000X	Physician Assistant	50.006715RX	OH

General Provider Information

NPI Number	:	1134795529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY FRANCES GREEN PA-C

Provider Business Mailing Address
First Line	:	3545 VISTA AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-1053
Country	:	US
Telephone Number	:	217-549-6361
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 PIEDMONT AVE STE 7200
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-4224
Country	:	US
Telephone Number	:	134-758-7875
Fax Number	:	513-929-7239

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

Provider Enumeration Date	:	05/27/2021
Last Update Date	:	06/08/2021

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Directions to “ EMILY FRANCES GREEN PA-C” Practice Location

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