Individual
NICKI GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
517 W BEAUTIFUL LN, PHOENIX, AZ 85041-8048
(708) 955-8388
Mailing address
517 W BEAUTIFUL LN, PHOENIX, AZ 85041-8048
(708) 955-8388
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
2770314
AZ
Other
Enumeration date
03/25/2008
Last updated
03/25/2008
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