Individual
JACQUATA GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4140 APPIAN WAY CT APT F, GAHANNA, OH 43230-5413
(614) 929-1807
Mailing address
4140 APPIAN WAY CT APT F, GAHANNA, OH 43230-5413
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
154934
OH
Other
Enumeration date
06/28/2018
Last updated
06/28/2018
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