Provider Demographics
NPI:1407807548
Name:GREEN, DEBORAH (CNM)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 S GARY AVE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2228
Mailing Address - Country:US
Mailing Address - Phone:630-893-5230
Mailing Address - Fax:630-893-5837
Practice Address - Street 1:245 S GARY AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2228
Practice Address - Country:US
Practice Address - Phone:630-893-5230
Practice Address - Fax:630-893-5837
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-162592163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041-162592OtherRN LICENSE
IL209-004691OtherAPN LICENSE