MEDICARE: SADE GREEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator		MO

General Provider Information

NPI Number	:	1114452182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SADE GREEN

Provider Business Mailing Address
First Line	:	616 N 7TH ST APT 918
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63101-1336
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	616 N 7TH ST APT 918
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63101-1336
Country	:	US
Telephone Number	:	314-319-9009
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2017
Last Update Date	:	04/26/2017

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Directions to “ SADE GREEN ” Practice Location

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