Individual
MS. PENNY M GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
725 S JAMES CAMPBELL BLVD, COLUMBIA, TN 38401-5962
(931) 728-5607
(931) 728-8354
Mailing address
PO BOX 299, MANCHESTER, TN 37349-0299
(931) 728-5607
(931) 728-8354
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
11236
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3627696
—
TN
05
—
3627699
—
TN
01
—
4027418
BLUECROSS
TN
Enumeration date
06/13/2006
Last updated
07/09/2007
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