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NPI Code Detail

MEDICARE: ROBERTA JEANNE GREEN QMHA

MEDICARE: ROBERTA JEANNE GREEN QMHA
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 : 1760536296
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERTA JEANNE GREEN QMHA
Provider Business Mailing Address
First Line : 617 NE 91ST AVE
Second Line :
City : VANCOUVER
State : WA
Zip : 98664-3220
Country : US
Telephone Number : 360-944-0047
Fax Number :
Provider Business Practice Location Address
First Line : 7621 N PORTSMOUTH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97203-5953
Country : US
Telephone Number : 503-240-7599
Fax Number : 503-240-8066
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2007
Last Update Date : 07/08/2007

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Directions to “ ROBERTA JEANNE GREEN QMHA” Practice Location

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