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NPI Code Detail

MEDICARE: JOANNA PATRICE GREEN

MEDICARE: JOANNA PATRICE 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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1285334300
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOANNA PATRICE GREEN
Provider Business Mailing Address
First Line : 12320 INTERSTATE 30
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72210-7027
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12320 INTERSTATE 30
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72210-7027
Country : US
Telephone Number : 501-410-1567
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2023
Last Update Date : 03/07/2023

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Directions to “ JOANNA PATRICE GREEN ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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