Provider Demographics
NPI:1104225820
Name:GREEN, GEOFFREY SHELDON (RN)
Entity type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:SHELDON
Last Name:GREEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5308 EASTVIEW ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-2260
Mailing Address - Country:US
Mailing Address - Phone:307-287-4951
Mailing Address - Fax:307-778-4386
Practice Address - Street 1:5308 EASTVIEW ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-2260
Practice Address - Country:US
Practice Address - Phone:307-287-4951
Practice Address - Fax:307-778-4386
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY17869163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY17869OtherWYOMING STATE BOARD OF NURSING