Individual
CHADE B GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1600 NORTH MAIN, LOVINGTON, NM 88260-2830
(575) 396-6611
(575) 396-1454
Mailing address
1600 NORTH MAIN, LOVINGTON, NM 88260-2830
(575) 396-6611
(575) 396-1454
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
5647
AZ
363AM0700X
Medical Physician Assistant
Primary
PA2014-0082
NM
363AS0400X
Surgical Physician Assistant
5647
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
74921533
—
NM
Enumeration date
03/04/2014
Last updated
05/11/2017
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