Provider Demographics
NPI:1134795529
Name:GREEN, EMILY FRANCES (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:FRANCES
Last Name:GREEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-1053
Mailing Address - Country:US
Mailing Address - Phone:217-549-6361
Mailing Address - Fax:
Practice Address - Street 1:222 PIEDMONT AVE STE 7200
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-4224
Practice Address - Country:US
Practice Address - Phone:134-758-7875
Practice Address - Fax:513-929-7239
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006715RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant