Provider Demographics
NPI:1538551387
Name:GREEN, STEPHANIE L (APRN-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:GREEN
Suffix:
Gender:F
Credentials:APRN-C
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Other - First Name:
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Mailing Address - Street 1:784 HERCULES DR STE 110
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-8049
Mailing Address - Country:US
Mailing Address - Phone:802-448-9787
Mailing Address - Fax:802-448-9787
Practice Address - Street 1:108 HIGH ST
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2939
Practice Address - Country:US
Practice Address - Phone:866-476-1321
Practice Address - Fax:603-772-8091
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2023-03-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH045324-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3100464Medicaid