Individual
KOURTNEY GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3512 STELLHORN RD, FORT WAYNE, IN 46815-4631
(260) 483-9081
(260) 483-9196
Mailing address
PO BOX 392552, PITTSBURGH, PA 15251-9500
(260) 483-9081
(260) 483-9196
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
2013011851
MO
363L00000X
Nurse Practitioner
Primary
71005675A
IN
Other
Enumeration date
07/15/2014
Last updated
07/16/2020
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