Provider Demographics
NPI:1083082127
Name:GREEN, MARNI (DNP)
Entity Type:Individual
Prefix:DR
First Name:MARNI
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:DR
Other - First Name:MARNI
Other - Middle Name:GREEN
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:27625 N 44TH ST
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-6623
Mailing Address - Country:US
Mailing Address - Phone:623-203-2965
Mailing Address - Fax:
Practice Address - Street 1:27625 N 44TH ST
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-6623
Practice Address - Country:US
Practice Address - Phone:623-203-2965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-07
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8061363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ197538Medicare PIN