Individual
MARYELLEN E GREENE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1990 N PROSPECT AVE, LECANTO, FL 34461-9792
(352) 527-6888
(352) 527-8818
Mailing address
1990 N PROSPECT AVE, LECANTO, FL 34461-9792
(352) 527-6888
(352) 527-8818
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9104960
FL
Other
Enumeration date
01/08/2007
Last updated
03/22/2012
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