Jennifer Susan Green, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704144751 Issued in MI

Practice address

28535 Lake Park Dr W
Farmington Hills, MI 48331-4621

Phone

(248) 225-2826

NPI assigned

Apr 29, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Mrs. Jennifer Susan Prog Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1304035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709856000000",
    "number": "1326339938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28535 LAKE PARK DR W",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483314621",
            "telephone_number": "248-225-2826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28535 LAKE PARK DR W",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483314621",
            "telephone_number": "248-225-2826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "JENNIFER",
        "middle_name": "SUSAN",
        "name_prefix": "Ms.",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-04-29",
        "last_updated": "2024-03-08",
        "certification_date": "2024-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704144751",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704144751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "PROG",
            "middle_name": "SUSAN",
            "prefix": "MRS.",
            "credential": "RN, BSN, MSN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jade M Green
• Jamee Green
• Jasmine Green
• Jazmyne Green
• Jennifer Marie Green
• Jevonne Green
• Jillian Green
• Jocelyn Green
• Jody Green
• John Green

• Family Nurse Practitioner in Farmington Hills, MI
• Providers in Farmington Hills, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2024; 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.