Provider Demographics
NPI:1902580731
Name:GREEN, JOANNA RUPPEL (CRNP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:RUPPEL
Last Name:GREEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 PERRYS WELL RD
Mailing Address - Street 2:
Mailing Address - City:PITTSVIEW
Mailing Address - State:AL
Mailing Address - Zip Code:36871-2671
Mailing Address - Country:US
Mailing Address - Phone:334-714-7142
Mailing Address - Fax:
Practice Address - Street 1:820 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-1899
Practice Address - Country:US
Practice Address - Phone:334-688-7276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-147130363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty