Maryellen Boczar Green, F.N.P.

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

347863 Issued in CA

Practice address

5500 Campanile Dr
Sdsu Student Health Services
San Diego, CA 92182-0001

Phone

(619) 594-5281

Fax

(619) 594-3638

NPI assigned

Dec 17, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1197849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197849600000",
    "number": "1285817924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 CAMPANILE DRIVE",
            "address_2": "STUDENT HEALTH SERVICES",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921824701",
            "telephone_number": "619-594-5281",
            "fax_number": "619-594-3638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 CAMPANILE DR",
            "address_2": "SDSU STUDENT HEALTH SERVICES",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921820001",
            "telephone_number": "619-594-5281",
            "fax_number": "619-594-3638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "MARYELLEN",
        "middle_name": "BOCZAR",
        "credential": "F.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-12-17",
        "last_updated": "2007-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": "347863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Makenzie Green
• Marcel Green
• Marguerite Green, RN
• Marie Denise Green, M.D.
• Marilyn Marie Green, RBT
• Monica Green, FNP
• Nancy M. Green, MD
• Nicole Michele Green
• Patricia Green
• Rachel Paige Green

• Student in an Organized Health Care Education/Training Program in San Diego, CA
• Providers in San Diego, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.