Individual
JAUCLYN RENEE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
800 MEDICAL CENTER DR, FAIRMONT, MN 56031-4575
(507) 238-8100
Mailing address
2884 SIMMONS RD, DRUMMONDS, TN 38023-4958
(901) 230-0489
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
25205
TN
363L00000X
Nurse Practitioner
Primary
6876
MN
Other
Enumeration date
08/15/2019
Last updated
11/11/2020
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