Individual
KANISHA RENEE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3840 ROSIN CT, SACRAMENTO, CA 95834-1639
(916) 230-2748
Mailing address
3840 ROSIN CT, SACRAMENTO, CA 95834-1639
(916) 230-2748
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
—
—
175T00000X
Peer Specialist
Primary
MPSS-MWBXCL
CA
Other
Enumeration date
10/24/2014
Last updated
07/18/2023
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