MEDICARE: SONJI ANTOINETTE 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	104100000X	Social Worker		NV

General Provider Information

NPI Number	:	1952679441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONJI ANTOINETTE GREEN

Provider Business Mailing Address
First Line	:	1785 E SAHARA AVE
Second Line	:	SUITE 445
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3733
Country	:	US
Telephone Number	:	702-576-0534
Fax Number	:	702-369-5605

Provider Business Practice Location Address
First Line	:	1785 E SAHARA AVE
Second Line	:	SUITE 445
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3733
Country	:	US
Telephone Number	:	702-576-0534
Fax Number	:	702-369-5605

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

Provider Enumeration Date	:	12/12/2011
Last Update Date	:	12/12/2011

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Directions to “ SONJI ANTOINETTE GREEN ” Practice Location

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