Basic Information
| Provider Information | |||||||||
| NPI: | 1649366741 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREEN | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | O | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 PALMER ST | ||||||||
| Address2: | |||||||||
| City: | CALAIS | ||||||||
| State: | ME | ||||||||
| PostalCode: | 046191305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074548150 | ||||||||
| FaxNumber: | 2074540256 | ||||||||
| Practice Location | |||||||||
| Address1: | 37 PALMER ST | ||||||||
| Address2: | |||||||||
| City: | CALAIS | ||||||||
| State: | ME | ||||||||
| PostalCode: | 046191305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074543307 | ||||||||
| FaxNumber: | 2074543988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | R027181 | ME | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.