Provider Demographics
NPI:1174690713
Name:GREEN, ANGELA R (NP)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:R
Last Name:GREEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2158 INTELLIPLEX DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-8897
Practice Address - Country:US
Practice Address - Phone:317-392-3651
Practice Address - Fax:317-398-0538
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71000510363L00000X
IN71000510A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200221890Medicaid
IN200221890Medicaid
IN742420PMedicare PIN