Individual
MRS. TYESHIA SHANTELL GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4918 N 22ND ST, MILWAUKEE, WI 53209-5628
(414) 213-0501
Mailing address
4918 N 22ND ST, MILWAUKEE, WI 53209-5628
(414) 213-0501
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
3050002-031
WI
Other
Enumeration date
08/25/2009
Last updated
08/25/2009
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