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NPI Code Detail

MEDICARE: MRS. COY M. GREEN MA,APRN,BC

MEDICARE: MRS. COY M. GREEN MA,APRN,BC
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
1163W00000XRegistered NurseRN-071368IA

General Provider Information

NPI Number : 1154521839
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. COY M. GREEN MA,APRN,BC
Provider Business Mailing Address
First Line : 1129 W IRON SPRINGS RD
Second Line : #107
City : PRESCOTT
State : AZ
Zip : 86305-1623
Country : US
Telephone Number : 928-777-2377
Fax Number : 928-777-2378
Provider Business Practice Location Address
First Line : 1129 W IRON SPRINGS RD
Second Line : #107
City : PRESCOTT
State : AZ
Zip : 86305-1623
Country : US
Telephone Number : 928-777-2377
Fax Number : 928-777-2378
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2007
Last Update Date : 07/20/2007

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