Individual
MRS. AMANDA RENEE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
206 LEGION AVE, LEWISBURG, TN 37091-2898
(931) 359-1551
Mailing address
206 LEGION AVE, LEWISBURG, TN 37091-2898
(931) 359-1551
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0000077037
TN
Other
Enumeration date
02/22/2012
Last updated
02/22/2012
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