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NPI Code Detail

MEDICARE: CAROLINE GREEN PA

MEDICARE: CAROLINE GREEN PA
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
1363A00000XPhysician Assistant5981CO
2363A00000XPhysician Assistant

General Provider Information

NPI Number : 1841846193
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLINE GREEN PA
Provider Business Mailing Address
First Line : 1906 BLAKE AVE
Second Line :
City : GLENWOOD SPRINGS
State : CO
Zip : 81601-4227
Country : US
Telephone Number : 970-384-7140
Fax Number : 970-384-8133
Provider Business Practice Location Address
First Line : 1906 BLAKE AVE
Second Line :
City : GLENWOOD SPRINGS
State : CO
Zip : 81601-4227
Country : US
Telephone Number : 970-384-7140
Fax Number : 970-384-8133
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2019
Last Update Date : 02/04/2026

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Directions to “ CAROLINE GREEN PA” Practice Location

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