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Individual

LIZA M GREENE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1091 S BEACON BLVD, GRAND HAVEN, MI 49417-2607
(616) 604-0096
Mailing address
1310 WISCONSIN AVE, SUITE 101, GRAND HAVEN, MI 49417-2472
(616) 844-4528

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601007430
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0010-00802
STATE LICENSE
NC
01
5601007430
MI LICENSE
MI
Enumeration date
02/12/2007
Last updated
08/07/2015
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