Individual
TROY GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
210 W WALNUT ST, CANTON, IL 61520-2444
(309) 647-5240
Mailing address
210 W WALNUT ST, CANTON, IL 61520-2444
(309) 647-5240
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
041340485
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
MEDICARE
IL
Enumeration date
06/09/2009
Last updated
07/08/2013
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