Individual
ANDREA GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
STNA
Contact information
Practice address
115 BATH ST, ELYRIA, OH 44035-3501
(440) 494-5192
Mailing address
115 BATH ST, ELYRIA, OH 44035-3501
(440) 494-5192
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
401323941111
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0208731
—
OH
Enumeration date
04/29/2017
Last updated
04/29/2017
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