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General NPI Number Information
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NPI Number | 1033177324
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Entity Type | Individual
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Provider Name | BETH ANN MARIE GREEN PTA
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Gender | Female
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 334 MAIN ST
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City | DICKSON CITY
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State | PA
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Zip | 18519-1620
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Country | US
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Telephone | 570-307-1769
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Fax | 570-307-1771
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Provider Business Mailing Address
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Address Line | RR 3 BOX 114
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City | DALTON
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State | PA
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Zip | 18414-9415
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Country | US
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Telephone | 570-378-3242
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Fax | 570-307-1771
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | TE001143L
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License Number State | PA
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