Individual
MRS. MICHELLE RENAE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
419 W STATE ST, MANCELONA, MI 49659
(231) 587-9181
(231) 587-0923
Mailing address
PO BOX 769, MANCELONA, MI 49659-0769
(231) 587-9181
(231) 587-0923
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601005008
MI
Other
Enumeration date
06/21/2007
Last updated
06/15/2018
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