Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0200X | Nurse Practitioner - Pediatrics | F381703 | NY |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | R226548-7 | MN |
NPI | 1043374259 |
---|---|
Provider Name | Meghan Suzanne Green |
First Address | Minnetonka, MN 55305-1781 |
Second Address | Chaska, MN 55318-1459 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 24/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02576878 | (05) | NY |
149194DL | PREFERRED CARE (01) | NY |
P019381703 | BLUE CHOICE (01) | NY |