MEDICARE: CARMELLA GREEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372600000X	Adult Companion

General Provider Information

NPI Number	:	1194321265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMELLA GREEN

Provider Business Mailing Address
First Line	:	247 RUSSELL AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44311-1457
Country	:	US
Telephone Number	:	330-212-7609
Fax Number	:

Provider Business Practice Location Address
First Line	:	247 RUSSELL AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44311-1457
Country	:	US
Telephone Number	:	330-212-7609
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2020
Last Update Date	:	12/04/2020

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Directions to “ CARMELLA GREEN ” Practice Location

Language	Start Address	Practice Location

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