MEDICARE: MRS. NATASHA PATRICE GREEN NURSE PRACTITIONER

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN227804	GA

General Provider Information

NPI Number	:	1134852619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NATASHA PATRICE GREEN NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	26 GUNNER DR
Second Line	:
City	:	FORT MITCHELL
State	:	AL
Zip	:	36856-4339
Country	:	US
Telephone Number	:	334-540-9364
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 GUNNER DR
Second Line	:
City	:	FORT MITCHELL
State	:	AL
Zip	:	36856-4339
Country	:	US
Telephone Number	:	334-540-9364
Fax Number	:

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

Provider Enumeration Date	:	07/02/2022
Last Update Date	:	07/02/2022

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