Healthcare Provider Details

I. General information

NPI: 1669928255
Provider Name (Legal Business Name): JAZMINE GREENE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SAINT ANDREWS RD STE 407
SAGINAW MI
48638-5977
US

IV. Provider business mailing address

PO BOX 663
LAKELAND MI
48143-0663
US

V. Phone/Fax

Practice location:
  • Phone: 989-341-3653
  • Fax:
Mailing address:
  • Phone: 734-203-0181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: