Individual
MS. JENNIFER GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LM, CPM
Contact information
Practice address
2253 CALVERT ST, VIRGINIA BEACH, VA 23451-1739
(757) 339-4315
(757) 313-4596
Mailing address
2253 CALVERT ST, VIRGINIA BEACH, VA 23451-1739
(757) 339-4315
(757) 313-4596
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
0129-000104
VA
Other
Enumeration date
12/20/2014
Last updated
12/20/2014
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