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General NPI Number Information
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NPI Number | 1790247823
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Entity Type | Individual
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Provider Name | SARAH CHINELLE GREEN COMETOLOGIST
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Gender | Female
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Dates
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Enumeration Date | 04/06/2019
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 3402 BROOKHOLLOW DR
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City | LOUISVILLE
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State | KY
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Zip | 40220-5006
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Country | US
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Telephone | 502-533-2799
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Fax |
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Provider Business Mailing Address
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Address Line | 3402 BROOKHOLLOW DR
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City | LOUISVILLE
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State | KY
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Zip | 40220-5006
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Country | US
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Telephone | 502-533-2799
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 206490
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License Number State | KY
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