Provider Demographics
NPI:1497801443
Name:GREEN, NANCY L (MIDWIFE)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:L
Last Name:GREEN
Suffix:
Gender:F
Credentials:MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311A RADIO PARK DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475
Mailing Address - Country:US
Mailing Address - Phone:859-624-2010
Mailing Address - Fax:859-625-1229
Practice Address - Street 1:311A RADIO PARK DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475
Practice Address - Country:US
Practice Address - Phone:859-624-2010
Practice Address - Fax:859-625-1229
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1035270163W00000X
KY1864176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78000601Medicaid
KY78903127OtherGORDON SALTER MEDICAID GR