Provider Demographics
NPI:1164976411
Name:GREEN-YESU, TOLULOPE (FNP)
Entity Type:Individual
Prefix:
First Name:TOLULOPE
Middle Name:
Last Name:GREEN-YESU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 E BROADWAY BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-5908
Mailing Address - Country:US
Mailing Address - Phone:520-372-2272
Mailing Address - Fax:520-336-9163
Practice Address - Street 1:2030 E BROADWAY BLVD STE 102
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-5908
Practice Address - Country:US
Practice Address - Phone:520-372-2272
Practice Address - Fax:520-336-9163
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-03
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8870363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily