Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP9968 | AZ |
NPI | 1013458629 |
---|---|
Provider Name | Mrs. Jennifer Lindsey Atwood Green |
First Address | Tempe, AZ 85281-7248 |
Second Address | Tempe, AZ 85281-7248 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2017 |
Last Update Date | 15/03/2017 |