Individual
SHANEISE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1312 AGAPE WAY, BRYAN, TX 77803-7803
(817) 818-8870
(817) 818-8870
Mailing address
1312 AGAPE WAY, BRYAN, TX 77803-7803
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
34750706
TX
Other
Enumeration date
02/19/2018
Last updated
02/19/2018
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