Individual
LAGRETTA GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
200 E 115TH ST, CHICAGO, IL 60628-5015
(312) 747-2823
(312) 747-2851
Mailing address
200 E 115TH ST, CHICAGO, IL 60628-5015
(312) 747-9505
(312) 747-2851
Taxonomy
Speciality
Code
Description
License number
State
363LC1500X
Community Health Nurse Practitioner
Primary
209-000642
IL
Other
Enumeration date
05/07/2007
Last updated
06/24/2010
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