MEDICARE: VERONICA MICHELLE GREEN F.N.P

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	363LF0000X	Family Nurse Practitioner	AP128731	TX
2	363LF0000X	Family Nurse Practitioner	276911	AZ

General Provider Information

NPI Number	:	1710357181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERONICA MICHELLE GREEN F.N.P

Provider Business Mailing Address
First Line	:	3003 N CENTRAL AVE STE 1175
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-0002
Country	:	US
Telephone Number	:	888-698-6727
Fax Number	:	602-564-6246

Provider Business Practice Location Address
First Line	:	5525 E RIVER RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85750-1949
Country	:	US
Telephone Number	:	602-755-0800
Fax Number	:	602-564-6246

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

Provider Enumeration Date	:	09/29/2015
Last Update Date	:	07/22/2022

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