Individual
AMANDA GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
341 WHITEVILLE RD NW, SHALLOTTE, NC 28470-4507
(877) 935-5255
Mailing address
30 RAILROAD AVE, ALBANY, MN 56307-9379
(320) 845-2157
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-15310
NC
363A00000X
Physician Assistant
14006
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14006
MEDICAL LICENSE
MN
Enumeration date
11/04/2020
Last updated
11/17/2025
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