Provider Demographics
NPI:1821098054
Name:GREEN, STELLA OSELGYAMFI (FNP)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:OSELGYAMFI
Last Name:GREEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:STELLA
Other - Middle Name:
Other - Last Name:GYAMFEI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:1106 N HWY 360
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-2559
Mailing Address - Country:US
Mailing Address - Phone:972-602-3018
Mailing Address - Fax:972-602-7337
Practice Address - Street 1:1106 HWY 360
Practice Address - Street 2:SUITE 203
Practice Address - City:GRANDPRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050
Practice Address - Country:US
Practice Address - Phone:972-602-3018
Practice Address - Fax:972-602-7337
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX676614363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150675006Medicaid
TX150675005Medicaid
TX150675003Medicaid
TX150675007Medicaid
TXP59331Medicare UPIN
TX8B5071Medicare ID - Type Unspecified00968R
TX8B5071Medicare PIN
TX8G7128Medicare PIN
TX150675007Medicaid
TX150675005Medicaid