Provider Demographics
NPI:1710357181
Name:GREEN, VERONICA MICHELLE (FNP)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:MICHELLE
Last Name:GREEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 N CENTRAL AVE STE 1175
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-0002
Mailing Address - Country:US
Mailing Address - Phone:888-698-6727
Mailing Address - Fax:602-564-6246
Practice Address - Street 1:5525 E RIVER RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-1949
Practice Address - Country:US
Practice Address - Phone:602-755-0800
Practice Address - Fax:602-564-6246
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128731363LF0000X
AZ276911363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily