Individual
MS. TERESA DIANE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
415 W GLADYS ST, SIKESTON, MO 63801-2733
(573) 475-9254
(573) 475-9254
Mailing address
415 W GLADYS ST, SIKESTON, MO 63801-2733
(573) 475-9254
(573) 475-9254
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
19920393
MO
Other
Enumeration date
11/30/2009
Last updated
11/30/2009
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