Individual
MRS. CHANHOM L GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
555 WARREN RD, ITHACA, NY 14850-1862
(607) 257-1555
(607) 697-8220
Mailing address
555 WARREN RD, ITHACA, NY 14850-1862
(607) 257-1555
(607) 257-1555
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
77531301
NY
Other
Enumeration date
09/21/2021
Last updated
09/21/2021
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