Individual
NYISHA O GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNA, CMA
Contact information
Practice address
1177 REILEY CT, RACINE, WI 53403-1759
(260) 308-2961
(262) 260-8433
Mailing address
1177 REILEY CT, RACINE, WI 53403-1759
(262) 308-2961
(262) 260-8433
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
H5K8N2B6
GA
Other
Enumeration date
01/27/2014
Last updated
01/27/2014
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