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General NPI Number Information
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NPI Number | 1407472780
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Entity Type | Individual
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Provider Name | ALLISON GREEN NP
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Gender | Female
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Dates
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Enumeration Date | 06/22/2020
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Last Update Date | 05/05/2021
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Provider Practice Location Address
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Address Line | 406 KENT ST
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City | PORTLAND
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State | MI
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Zip | 48875-1707
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Country | US
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Telephone | 517-647-4166
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Fax | 517-647-2473
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Provider Business Mailing Address
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Address Line | 8454 CARRIAGE LN
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City | PORTLAND
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State | MI
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Zip | 48875-9805
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Country | US
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Telephone | 517-449-7106
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704307008
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License Number State | MI
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