Jean Green

Individual provider Active NPI Medical-Surgical Registered Nurse · Ocilla, GA

NPI 1114337359 · NPPES record last updated Apr 28, 2014

Key facts

NPI
1114337359
Entity type
Individual (NPI type 1)
Primary specialty
Medical-Surgical Registered Nurse 163WM0705X
License
RN174038 (GA)
Practice address
232 Crepe Myrtle Cir
Ocilla, GA 31774-3348
Phone
(229) 325-6068
NPI assigned
Apr 28, 2014
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
RN174038GAMDMedical-Surgical Registered Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Medical-Surgical Registered Nurse 163WM0705X RN174038 GA Yes

Addresses

Primary practice location

232 Crepe Myrtle Cir
Ocilla, GA 31774-3348

Mailing address

232 Crepe Myrtle Cir
Ocilla, GA 31774-3348
Phone (229) 325-6068

Other providers in Ocilla, GA

All providers in Ocilla, GA · Medical-Surgical Registered Nurse in Georgia

Sources for this page

Verify at the official NPI Registry.