Healthcare Provider Details

I. General information

NPI: 1508312224
Provider Name (Legal Business Name): KARRIE GREEN CD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

28718 525TH AVE
AUSTIN MN
55912-5736
US

IV. Provider business mailing address

28718 525TH AVE
AUSTIN MN
55912-5736
US

V. Phone/Fax

Practice location:
  • Phone: 507-210-1655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: