Individual
ALYCIA MARIE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
908 DUPONT RD, LOUISVILLE, KY 40207-4602
(502) 749-7909
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1104001
KY
363LF0000X
Family Nurse Practitioner
Primary
3015106
KY
Other
Enumeration date
08/03/2020
Last updated
09/14/2020
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