MEDICARE: MS. ANGELA R. 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	363L00000X	Nurse Practitioner	71000510	IN
2	363LF0000X	Family Nurse Practitioner	71000510A	IN

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	:	1174690713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA R. GREEN NP

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2158 INTELLIPLEX DR
Second Line	:	SUITE 200
City	:	SHELBYVILLE
State	:	IN
Zip	:	46176-8897
Country	:	US
Telephone Number	:	317-392-3651
Fax Number	:	317-398-0538

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/14/2022

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