Provider Demographics
NPI:1467986844
Name:GREEN, LINDA ANN (NP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ANN
Last Name:GREEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:OGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4015 GATEWAY BLVD STE 2120
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-9460
Mailing Address - Country:US
Mailing Address - Phone:812-842-0907
Mailing Address - Fax:812-464-4485
Practice Address - Street 1:4015 GATEWAY BLVD STE 2120
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-9460
Practice Address - Country:US
Practice Address - Phone:812-842-0907
Practice Address - Fax:812-490-7015
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28150843A163W00000X
IN0000363LA2100X
IN71007113A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care