Provider Demographics
NPI:1679563936
Name:GREEN, NATHAN B (DO)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:B
Last Name:GREEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 TIGER LILY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5587
Mailing Address - Country:US
Mailing Address - Phone:402-420-7000
Mailing Address - Fax:402-420-6969
Practice Address - Street 1:4101 TIGER LILY RD STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5587
Practice Address - Country:US
Practice Address - Phone:402-420-7000
Practice Address - Fax:402-420-6969
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE343207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE03816OtherBCBS
NE239782OtherMIDLANDS CHOICE
KS200269640AMedicaid
NE3600324OtherUHC
NE3600324OtherUHC
H78052Medicare UPIN
NE91186278513Medicaid
NE276298Medicare PIN