Healthcare Provider Details

I. General information

NPI: 1962703447
Provider Name (Legal Business Name): JOSHUA D. GREEN N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 08/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 KILBURN ST
BURLINGTON VT
05401-4750
US

IV. Provider business mailing address

13 KILBURN ST
BURLINGTON VT
05401-4750
US

V. Phone/Fax

Practice location:
  • Phone: 802-238-8603
  • Fax: 802-732-9133
Mailing address:
  • Phone: 802-238-8603
  • Fax: 802-732-9133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number099.0072105
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: