Provider Demographics
NPI:1861448102
Name:GREEN, JAIME M (APRN/CNP)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:M
Last Name:GREEN
Suffix:
Gender:F
Credentials:APRN/CNP
Other - Prefix:MRS
Other - First Name:JAIME
Other - Middle Name:M
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN/CNP
Mailing Address - Street 1:632 W GIBSON RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-5169
Mailing Address - Country:US
Mailing Address - Phone:530-668-2605
Mailing Address - Fax:
Practice Address - Street 1:632 W GIBSON RD
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-5169
Practice Address - Country:US
Practice Address - Phone:530-668-2605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP20468363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA552312OtherRN LICENSE
CA20468OtherFURNISHING LICENSE
CANP20468OtherNURSE PRACTITIONER
CANP20468OtherNURSE PRACTITIONER
Q57541Medicare UPIN