Individual
THEODORE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3716 PACIFIC AVE STE E, TACOMA, WA 98418-7836
(253) 474-5141
Mailing address
3716 PACIFIC AVE STE E, TACOMA, WA 98418-7836
(253) 474-5141
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP61015452
WA
Other
Enumeration date
10/25/2019
Last updated
03/18/2021
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