Individual
MS. BRANDY LATIECHA GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10011 J ST, OMAHA, NE 68127-1106
(402) 896-9988
(402) 896-6111
Mailing address
4980 S 118TH ST, OMAHA, NE 68137-2200
(402) 896-3884
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
23140
NE
Other
Enumeration date
05/16/2017
Last updated
05/16/2017
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