Individual
INA GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
4335 SE 15TH ST, DEL CITY, OK 73115-3001
(405) 600-9988
(405) 600-9989
Mailing address
PO BOX 14587, OKLAHOMA CITY, OK 73113-0587
(405) 600-9988
(405) 600-9989
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1010
OK
Other
Enumeration date
01/19/2009
Last updated
01/19/2009
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