Individual
MADISON GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1519 3RD ST SE, PUYALLUP, WA 98372-3742
(253) 841-8939
Mailing address
5141 N 30TH ST, TACOMA, WA 98407-3305
(360) 689-2262
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA61222553
WA
Other
Enumeration date
01/05/2021
Last updated
10/28/2021
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