Individual
MRS. ILEANA GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1400 BROADWAY, GARY, IN 46407
(219) 882-2305
Mailing address
1400 BROADWAY, GARY, IN 46407-1310
(219) 882-2305
(219) 882-1038
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
28195095A
IN
Other
Enumeration date
05/03/2018
Last updated
05/15/2019
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