Provider Demographics
NPI:1336641307
Name:GREEN, EMILY ROSE (MSN, CNM, WHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:ROSE
Last Name:GREEN
Suffix:
Gender:F
Credentials:MSN, CNM, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 KIMBALL ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-2620
Mailing Address - Country:US
Mailing Address - Phone:215-380-5944
Mailing Address - Fax:
Practice Address - Street 1:918 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2502
Practice Address - Country:US
Practice Address - Phone:610-525-6086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW010485367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife