Individual
MS. TERESA GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
151 N MAIN ST, DECATUR, IL 62523-1206
(217) 362-6262
Mailing address
151 N MAIN, DECATUR, IL 62523
(217) 362-6262
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
T370765549
IL
Other
Enumeration date
11/17/2009
Last updated
11/17/2009
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