Provider Demographics
NPI:1881926160
Name:GREEN, JODY L (RN)
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:L
Last Name:GREEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 W 1500 N
Mailing Address - Street 2:PO BOX 412
Mailing Address - City:NEPHI
Mailing Address - State:UT
Mailing Address - Zip Code:84648
Mailing Address - Country:US
Mailing Address - Phone:435-623-3000
Mailing Address - Fax:435-623-3123
Practice Address - Street 1:48 W 1500 N
Practice Address - Street 2:
Practice Address - City:NEPHI
Practice Address - State:UT
Practice Address - Zip Code:84648
Practice Address - Country:US
Practice Address - Phone:435-623-3000
Practice Address - Fax:435-623-3123
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4877049-3102163W00000X
UT004749163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator