Individual
DESIRE D. GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
101 POTTERS LN, CLARKSVILLE, IN 47129-1000
(443) 383-9300
(855) 866-8710
Mailing address
909 RIDGEBROOK RD STE 300, SPARKS GLENCOE, MD 21152-9477
(443) 383-9300
(855) 866-8710
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71005375A
IN
363LF0000X
Family Nurse Practitioner
Primary
71005375A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201288380
—
IN
Enumeration date
04/22/2015
Last updated
11/17/2022
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