1790906840 NPI number — SUSAN ROBIN GREEN MSN, CRNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790906840 NPI number — SUSAN ROBIN GREEN MSN, CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREEN
Provider First Name:
SUSAN
Provider Middle Name:
ROBIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790906840
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8201 HENRY AVE
Provider Second Line Business Mailing Address:
C15
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-487-1017
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 E CHELTEN AVE
Provider Second Line Business Practice Location Address:
PHILADELPHIA PUBLIC HEALTH DEPT HEALTH CARE CENTER #9
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-685-5701
Provider Business Practice Location Address Fax Number:
215-685-5257
Provider Enumeration Date:
05/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  RN266978L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RN266978L . This is a "REGISTERED NURSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: VP004121G . This is a "OBSTETRIC GYNECOLOGY" identifier . This identifiers is of the category "OTHER".




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