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General NPI Number Information
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NPI Number | 1144632456
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Entity Type | Individual
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Provider Name | CASSANDRA GREEN R.N., CSFA
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Gender | Female
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Dates
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Enumeration Date | 05/21/2014
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 201 2ND AVE
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City | MONTGOMERY
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State | IL
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Zip | 60538-1531
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Country | US
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Telephone | 630-777-1414
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 309
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City | MONEE
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State | IL
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Zip | 60449-0309
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Country | US
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Telephone | 708-235-0352
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Fax | 708-328-3668
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 149334
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License Number State | IL
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