Individual
ANNTANISHA DELORES GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1771 E FLAMINGO RD, LAS VEGAS, NV 89119-5155
(702) 560-2192
Mailing address
5055 E CHARLESTON BLVD APT B101, LAS VEGAS, NV 89104-6465
(661) 349-3799
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
—
—
Other
Enumeration date
01/19/2023
Last updated
01/19/2023
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