Organization
JEAN GREEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEAN GREEN (OWNER)
(508) 393-1920
Entity
Organization
Contact information
Practice address
588 MAIN ST, SHREWSBURY, MA 01545-2920
(509) 393-1920
Mailing address
50 CHERRY ST, NORTHBOROUGH, MA 01532-1209
(508) 393-1920
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
843
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39221
HARVARD PILGRIM ID
MA
01
—
725391
TUFTS PROVIDER ID
MA
01
—
LD0054
BLUECROSS BLUESHIELD ID
MA
Enumeration date
11/12/2006
Last updated
11/09/2012
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