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General NPI Number Information
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NPI Number | 1285907485
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Entity Type | Individual
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Provider Name | MAYNARD A GREEN
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Gender | Male
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Dates
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Enumeration Date | 02/17/2012
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Last Update Date | 02/17/2012
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Provider Practice Location Address
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Address Line | 955 LADERA DR
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City | CARSON CITY
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State | NV
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Zip | 89701-2048
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Country | US
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Telephone | 775-445-9392
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Fax |
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Provider Business Mailing Address
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Address Line | 955 LADERA DR
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City | CARSON CITY
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State | NV
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Zip | 89701-2048
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Country | US
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Telephone | 775-445-9392
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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