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General NPI Number Information
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NPI Number | 1144829870
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Entity Type | Individual
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Provider Name | JOAN GREEN
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Gender | Female
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Dates
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Enumeration Date | 10/23/2020
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Last Update Date | 10/23/2020
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Provider Practice Location Address
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Address Line | 11350 RANDOM HILLS RD
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City | FAIRFAX
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State | VA
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Zip | 22030-6044
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Country | US
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Telephone | 202-054-0012
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Fax |
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Provider Business Mailing Address
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Address Line | 1412 NE 14TH CT
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-1342
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Country | US
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Telephone | 954-200-2991
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Fax |
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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 | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State | FL
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