Individual
MISS TERYN ASHLI GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
212 5TH AVE, HELENA, MT 59601-4204
(406) 560-1715
Mailing address
212 5TH AVE, HELENA, MT 59601-4204
(406) 560-1715
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MED-PAC-LIC-80097
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MED-PAC-LIC-80097
STATE OF MONTANA PHYSICIAN ASSISTANT LICENSE
MT
Enumeration date
05/05/2020
Last updated
05/05/2020
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