Individual
MIYOKO STEPHANIE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2446 RESEARCH PKWY, SUITE 200, COLORADO SPRINGS, CO 80920-1087
(719) 623-1050
(719) 623-1052
Mailing address
2446 RESEARCH PKWY, SUITE 200, COLORADO SPRINGS, CO 80920-1087
(719) 623-1050
(719) 623-1052
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA0003732
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04927729
—
CO
Enumeration date
07/09/2013
Last updated
11/26/2018
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