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Individual
DR. AMANDA U. GREEN
Active
Individual
DR. AMANDA U. GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP,FNP-C
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
217075
SC
363L00000X
Nurse Practitioner
Primary
22248
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP5922
—
SC
01
—
SC2315A634
MEDICARE PTAN
SC
Enumeration date
07/09/2014
Last updated
10/14/2019
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