Individual
SUSAN DIANE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
307 E COURT ST, JACKSONVILLE, IL 62650-2019
(217) 370-7852
Mailing address
307 E COURT ST, JACKSONVILLE, IL 62650-2019
(217) 370-7852
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
06/12/2023
Last updated
06/20/2023
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