Individual
MEGHAN SUZANNE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
111 HUNDERTMARK RD, #420, CHASKA, MN 55318-1459
(952) 448-3847
(952) 448-5083
Mailing address
14001 RIDGEDALE DR, #100, MINNETONKA, MN 55305-1781
(952) 473-0211
(952) 473-7908
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
F381703
NY
363LP0200X
Pediatric Nurse Practitioner
Primary
R226548-7
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02576878
—
NY
01
—
149194DL
PREFERRED CARE
NY
01
—
P019381703
BLUE CHOICE
NY
Enumeration date
12/21/2006
Last updated
10/24/2017
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