MEDICARE: DEBORAH GREEN CNM

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	163W00000X	Registered Nurse	041-162592	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	041-162592	OTHER	IL	RN LICENSE
2	209-004691	OTHER	IL	APN LICENSE

General Provider Information

NPI Number	:	1407807548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH GREEN CNM

Provider Business Mailing Address
First Line	:	245 S GARY AVE
Second Line	:	LOWER LEVEL
City	:	BLOOMINGDALE
State	:	IL
Zip	:	60108-2228
Country	:	US
Telephone Number	:	630-893-5230
Fax Number	:	630-893-5837

Provider Business Practice Location Address
First Line	:	245 S GARY AVE
Second Line	:	LOWER LEVEL
City	:	BLOOMINGDALE
State	:	IL
Zip	:	60108-2228
Country	:	US
Telephone Number	:	630-893-5230
Fax Number	:	630-893-5837

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

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	01/11/2012

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Directions to “ DEBORAH GREEN CNM” Practice Location

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