Individual
HOLLY GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3688 SAND CREEK RD, FARMINGTON, MO 63640-7350
(573) 756-2917
(573) 756-7347
Mailing address
3688 SAND CREEK RD, FARMINGTON, MO 63640-7350
(573) 756-2917
(573) 756-7347
Taxonomy
Speciality
Code
Description
License number
State
376G00000X
Nursing Home Administrator
Primary
043352
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
043352
—
MO
Enumeration date
07/17/2015
Last updated
07/17/2015
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