Individual
MELINDA DAWN GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MASSAGE PRACTITIONER
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
10346856-3102
UT
225700000X
Massage Therapist
Primary
1046856-4107
UT
Other
Enumeration date
11/20/2020
Last updated
11/20/2020
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