Individual
LORI SHEA JEAN GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
313 FEDERAL DR NW STE 130, CORYDON, IN 47112-3099
(812) 734-3952
Mailing address
330 SEVEN SPRINGS WAY, BRENTWOOD, TN 37027-5098
(615) 920-7906
(615) 920-8938
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
3005070
KY
363LF0000X
Family Nurse Practitioner
Primary
71000547A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1017630001
DMERC
IN
01
—
271288
ANTHEM
IN
05
—
7100151870
—
KY
Enumeration date
06/20/2006
Last updated
12/09/2020
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