Active NPI
Lagretta Green, NP
- Community Health Nurse Practitioner
- Chicago, IL
National Provider Identifier
1639382807
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Nurse Practitioner
- License
- 209-000642
- Practice address
- 200 E 115TH St
Chicago, IL 60628-5015 - Phone
- (312) 747-2823
- Fax
- (312) 747-2851
- NPI assigned
- May 7, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Nurse Practitioner | 363LC1500X | 209-000642 | IL | Primary |
Addresses
Primary practice location
200 E 115TH St
Chicago, IL 60628-5015
Mailing address
200 E 115TH St
Chicago, IL 60628-5015
Phone (312) 747-9505
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209-000642 | IL | MD | Community Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277337600000",
"number": "1639382807",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 E 115TH ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606285015",
"telephone_number": "312-747-9505",
"fax_number": "312-747-2851"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 E 115TH ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606285015",
"telephone_number": "312-747-2823",
"fax_number": "312-747-2851"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "LAGRETTA",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-07",
"last_updated": "2010-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "363LC1500X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Community Health",
"state": "IL",
"license": "209-000642",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.