Provider Demographics
NPI:1528175049
Name:GREEN, AMY JO (RN, MSN, CRNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JO
Last Name:GREEN
Suffix:
Gender:F
Credentials:RN, MSN, CRNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:JO
Other - Last Name:KRIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MSN, CRNP
Mailing Address - Street 1:2340 BETHEL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-2978
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:412-831-2407
Practice Address - Street 1:1001 BRINTON RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221-4533
Practice Address - Country:US
Practice Address - Phone:412-977-2431
Practice Address - Fax:888-816-8109
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP006399B363LF0000X, 364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PATP006399BOtherLICENSE
PAQ75926Medicare UPIN