Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | COA.19064-NP | OH |
NPI | 1235593716 |
---|---|
Provider Name | Jennifer Green |
First Address | Cincinnati, OH 45220-2475 |
Second Address | Cincinnati, OH 45220-2475 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2016 |
Last Update Date | 02/05/2016 |