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Individual

MISS TINA MARIE GREEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CRNP

Contact information

Practice address
402 E SYCAMORE RD, BOX 398, SNOW SHOE, PA 16874-8832
(814) 387-6857
(814) 387-6870
Mailing address
2135 APPLE LN, BOX 31, NORTH BEND, PA 17760-9423
(570) 923-2556

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN520073L
PA
363L00000X
Nurse Practitioner
Primary
VP006945B
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
017968
RX AUTH
PA
05
101182180
PA
01
F1104016
NATIONAL AANP-CERT
Enumeration date
07/20/2005
Last updated
09/12/2013
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