Individual
JACQUELINE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4117 NW 122ND ST STE C, OKLAHOMA CITY, OK 73120-8878
(405) 401-8136
Mailing address
600 OLD HOME PL, YUKON, OK 73099-9716
(405) 401-8136
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OCC-03720
OK
Other
Enumeration date
10/17/2014
Last updated
10/17/2014
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