MEDICARE: MRS. DESTINY C GREEN RN

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	1108493-30	WI
2	253Z00000X	In Home Supportive Care Agency		WI
3	343900000X	Non-emergency Medical Transport (VAN)		WI
4	385H00000X	Respite Care		WI
5	251E00000X	Home Health Agency		WI

General Provider Information

NPI Number	:	1669314340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DESTINY C GREEN RN

Provider Business Mailing Address
First Line	:	6100 N 42ND ST # 108
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-3560
Country	:	US
Telephone Number	:	414-795-9761
Fax Number	:

Provider Business Practice Location Address
First Line	:	6100 N 42ND ST # 108
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-3560
Country	:	US
Telephone Number	:	414-795-9761
Fax Number	:

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

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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